Matteo Cavaliere

Comparison of the Effectiveness and Safety of Radiofrequency Turbinoplasty and Traditional Surgical Technique in Treatment of Inferior Turbinate Hypertrophy

OBJECTIVES: Inferior turbinate hypertrophy is one of the major causes of nasal airway obstruction. Medical treatment often produces insufficient improvements. In these cases, surgical reduction of inferior turbinates can be proposed. Many different techniques are currently available. We prospectively evaluate the safety and effectiveness of radiofrequency volumetric tissue reduction (RFVTR) compared with the traditional surgical technique. METHODS: The study was conducted on 3 groups of 75 patients with symptoms and signs of nasal obstruction associated with inferior turbinate hypertrophy refractory to medical therapy. In group A, the turbinoplasty (TP) was performed using the classical surgical submucosal resection; in group B, the RFVTR was applied to inferior turbinate; and group C patients were not treated and served as control subjects. Nasal endoscopy, visual analogue scale (VAS), anterior active positional rhinomanometry, and saccharin tests were used to assess treatment outcomes at the end of week 1 and months 1 and 3 after surgery. RESULTS: Turbinate edema and secretions decreased significantly (P < 0.05) in groups A and B from 1 month after surgery. The secretions in group A increased temporarily on the seventh day after surgery. Concerning the nasal obstruction and related symptoms, significant improvement was observed at 1 month after treatment in all patients (P < 0.05) and continued up to 3 months after surgery (P < 0.0001). Rhinomanometric measurements demonstrated a significant nasal flow increase at 3 months (P < 0.0001). The nasal mucociliary transport time increased in group A at week 1. The difference among the 3 groups at month 1 was observed not significant. CONCLUSION: In this study, we demonstrated that both RFVTR and TP are effective in improving nasal obstruction and related nasal symptoms. In support of the RFVTR, different factors are important: it can be performed in local anaesthesia; it does not require a nasal package; it does not cause either a change of mucociliary function or an increase of secretions and crusts; and the patient can be discharged immediately after treatment. Therefore, we suggest that the RFVTR offers an efficient, gentle, and function-maintaining alternative to TP. However, because of the short follow-up, future investigations are needed for a more exhaustive evaluation of equivalency of the 2 turbinate procedures. EBM RATING: B-2

The 11th Nerve Syndrome in Functional Neck Dissection

Objectives Assessment of the incidence of shoulder joint disability and evaluation of the role of a personal postoperative physical rehabilitative protocol therapy in reducing pain and shoulder dysfunction and improving the quality of life (QOL) of patients who have undergone functional neck dissection (FND) associated with total laryngectomy.

Monopolar and bipolar radiofrequency thermal ablation of inferior turbinates: 20-month follow-up.

OBJECTIVE: We prospectively evaluated the efficacy and morbidity of monopolar and bipolar radiofrequency volumetric tissue reduction (RFVTR) of inferior turbinates during a 20-month follow-up. METHODS: The study was conducted on 150 patients randomly assigned into two groups of 75 each. In group A, we used the bipolar device “Coblator II ENT” (Arthrocare Corp, Sunnyvale, CA) and in group B the monopolar device Somnoplasty (Somnus Medical Technologies, Inc, Sunnyvale, CA). Nasal endoscopy, visual analog scale, anterior active rhinomanometry, acoustic rhinometry, and saccharin tests were used to assess the outcomes of the treatments. RESULTS: Turbinate edema and nasal obstruction decreased significantly (P < 0.0001) in group A seven days after surgery and in group B from month 1. The nasal symptoms were significantly reduced in both groups from the first month (P < 0.0001). A significant increase (P < 0.0001) in nasal volume and decrease in nasal resistance were detected in the first month. No difference was found from three to 20 months after surgery (P > 0.5). CONCLUSION: We have shown that both methods of RFVTR can produce a long-term improvement on symptoms and on maintenance of nasal function.

Inhibition of p38 mitogen activated protein kinase controls airway inflammation in cystic fibrosis

Background: Cystic fibrosis (CF) airways are characterised by chronic inflammation, increased interleukin (IL)-8 secretion, and neutrophil activation which are considered the principal factors of morbidity and mortality in CF patients. Optimising management of this chronic inflammatory response is therefore a key issue of basic and clinical CF research. Several reports have addressed ways to manage CF airways inflammation, and an attractive therapeutic strategy may be the inhibition of the p38-mitogen activated protein kinase (p38-MAP-k) pathway. Methods: A new ex vivo model was used to study the mucosal inflammatory response to environmental airways stimuli. Nasal biopsy tissues from CF patients and controls were cultured ex vivo for 20 minutes, 4 hours, and 24 hours in the presence of lipopolysaccharide (LPS) from Pseudomonas aeruginosa (PA) with and without the p38-MAP-k inhibitor SB203580. Quantitative mRNA assessment, immunohistochemistry, and Western blots were used to detect the expression and modulation of inflammatory markers. Results: PA-LPS challenge induced a time dependent mucosal inflammation indicated by rapid epithelial activation, IL-8 release, COX-2 upregulation, and neutrophil migration to the upper mucosal layers. Some of these LPS induced changes (IL-8 release and neutrophil migration) were specific to CF tissues. SB203580 significantly controlled all LPS induced mucosal changes in CF tissues. Conclusion: These findings provide a rationale and proof of principle for the potential use of p38-MAP-k inhibitors to control inflammation in patients with CF.

Awake versus drug‐induced sleep endoscopy: Evaluation of airway obstruction in obstructive sleep apnea/hypopnoea syndrome

To compare the degree and patterns of upper airway obstruction, as detected by endoscopy with Müllers maneuver versus drug‐induced sleep endoscopy (DISE).

Guidelines for reprocessing nonlumened heat-sensitive ear/nose/throat endoscopes.

Endoscopes have become an indispensable instrument in the daily activity of the ear/nose/throat (ENT) department, but their use has introduced potential health risks such as the transmission of infection. Over the years, scientific knowledge has been consolidated regarding the most appropriate ways for the correct disinfection, and numerous guidelines have been issued for both digestive and respiratory endoscopes, whereas to date specific references to ENT endoscopes do not exist. The diagnostic ENT endoscope does not generally have an operative channel; it is shorter and thinner and has a much more frequent usage, also in the outpatient setting. As a consequence, the guidelines for digestive or respiratory endoscopes are not always functional for the ENT department in that they do not take into account the dynamics or the intensity of the work performed therein. This article proposes: 1) to standardize the correct way to carry out the disinfection procedure of heat‐sensitive nonlumened ENT endoscopes to reduce to a minimum the possibility of errors or oversights; and 2) to guarantee the disinfection within a limited time frame, appropriate for an ENT outpatient department. In the initial phase, the critical areas encountered in ENT endoscopy are determined. This is followed by an examination of the literature to identify existing guidelines for the reprocessing of endoscopes (mainly digestive and respiratory), with a view to establishing a common disinfection procedure for nonlumened ENT endoscopes. Finally, the new methods of disinfection developed specifically for the reprocessing of ENT endoscopes are examined and discussed.

Hyperbaric oxygen for idiopathic sudden hearing loss: is the routine application helpful?

Abstract Conclusion: We recommend the routine application of hyperbaric oxygen (HBO) in conjunction with intravenous steroid (IVS) for all patients with idiopathic sudden sensorineural hearing loss (ISSNHL). For best results, this therapy must be started within 14 days. Objective: To investigate the necessity of routine application of HBO therapy for ISSNHL. Methods: This was a retrospective cohort study. A total of 300 patients (300 diseased ears) were divided into 3 groups according to the therapy received: IVS (group A), HBO (group B), or IVS + HBO (group C). Patients in each treatment group were subdivided into subgroups according to the time of therapy initiation. The outcomes of their hearing recovery were classified into three recovery grades: good, fair, and poor. Results: The proportion of patients responding to therapy and those with complete recovery was the highest in the combined treatment group, 84% and 58%, respectively, regardless of the initial hearing levels. In all the groups, mean gains of cases in whom therapy was started in the first 2 weeks were significantly higher (p < 0.05) and hypercholesterolemia (>240 mg/dl) caused significantly worse responses (p < 0.05).

Endoscopic tympanoplasty in the treatment of chronic otitis media: our experience

Abstract Conclusion: The endoscopy ensures good surgical exposure of hidden areas, frequently sites of residual cholesteatoma. Also, the minimally invasive endoscopic approach is more respectful of anatomy and functionality of the middle ear, restoring and preserving mastoid mucosa, with faster healing time. Objectives: To investigate the benefits that the systematic use of endoscopy in middle ear surgery has made. Study design: Retrospective cohort studies. Method: Two groups of patients were surgically treated for inflammatory diseases of the middle ear. The first group refers to the Pre-Endoscopic period, the second one to the Endoscopic Period. This study analyzed the type of surgical approach (Transcanalar vs Retroauricolar) in all cases treated and the differences in incidence of residual disease in the cases treated for cholesteatoma. Results: The oto-endoscopy led to a significant increase (p < .01) of the transcanalar approach and to a significant reduction (p < .05) of residual cholesteatoma at the second look surgery.

Tragal cartilage shield tympanoplasty: our technique and results in 612 cases

Abstract Conclusion: This study reveals that tragal cartilage tympanoplasty is a reliable technique, it has a high degree of graft take, and the tympanic re-aeration and hearing results are satisfactory. Objective: Cartilage is the grafting material of choice in advanced pathologies of the middle ear while the indications for its routine use remain controversial. The purpose of this study was to report our long-term experience with the ‘tragal cartilage shield’ tympanoplasty. Methods: This was a retrospective case series. The study was conducted on 612 adult patients from January 2003 until January 2012. We evaluated graft take, pure-tone average air–bone gap (PTA-ABG), postoperative aeration, and complications. The mean postoperative follow-up was 68 months. Results: Sex, age, and tobacco smoke did not have any impact on postoperative results. Graft take was achieved in 99.35% of patients; there were no immediate postoperative complications. The overall average preoperative PTA-ABG was 44.95 ± 7.77 dB, whereas 1 year after surgery it was 10.66 ± 5.41 dB (p < 0.0001). Statistically significant improvement was observed up to 10 years after surgery. Moreover, we obtained a good tympanic ventilation (1 year after surgery, the average aeration score was 9.09 ± 1.93), which was stable up to 10 years.

Guidelines for Reprocessing Non-Lumened, Heat-Sensitive ENT Endoscopes

Endoscopes have become an indispensable instrument in the ENT department, but their use has introduced potential health risks such as the infection transmission. Numerous guidelines have been issued for both digestive and respiratory endoscopes, while to date specific references to ENT endoscopes do not exist. The diagnostic ENT endoscope does not generally have an operative channel, it is shorter, thinner and has a much more frequent usage. As a consequence the guidelines for digestive or respiratory endoscopes are not always functional for the ENT department. This paper proposes:1. to standardize the correct way to carry out the disinfection procedure of heat-sensitive non-lumened ENT endoscopes, 2. to guarantee the disinfection within a limited time frame, appropriate for an ENT out-patients department. In the initial phase the critical areas encountered in ENT endoscopy were determined. This was followed by a research of the literature in order to identify existing guidelines for the reprocessing of endoscopes with a view to establishing a common disinfection procedure of non-lumened ENT endoscopes. Finally, the new methods of disinfection, developed specifically for the reprocessing of ENT endoscopes were examined and discussed.