[show abstract][hide abstract] ABSTRACT: Adjuvant chemotherapy, advanced age, smoking, cardiopathies, diabetes, local infections, impaired immunocompetence, and malnutrition are potential cofactors in the genesis of aberrant wound healing and may thus play an important role in the genesis of tracheostomal stenosis. The aim of the study is to analyse the influence of the above-mentioned local and systemic risk factors in determining tracheostomal stenosis in patients who have undergone total laryngectomy and adjuvant radiotherapy. In 79 % of the cases, tracheostomal stenosis occurred within 12 months of surgery. Diabetes mellitus and local infection were the only factors that showed a statistically significant difference according to univariate and multivariate analysis. Diabetes mellitus and the related tracheostomal infection may be considered as risk factors for TS in patients who have undergone total laryngectomy and adjuvant radiotherapy.
Archives of Oto-Rhino-Laryngology 09/2013; · 1.29 Impact Factor
[show abstract][hide abstract] ABSTRACT: Olfactory identification ability implicates the integrity of the orbitofrontal cortex (OFC). The fronto-striatal circuits including the OFC have been involved in the neuropathology of Obsessive Compulsive Disorder (OCD). However, only a few studies have examined olfactory function in patients with OCD. The Brief Smell Identification Test (B-SIT) and tests from the Cambridge Neuropsychological Automated Battery (CANTAB) were administered to 25 patients with OCD and to 21 healthy matched controls. OCD patients showed a significant impairment in olfactory identification ability as well as widely distributed cognitive deficits in visual memory, executive functions, attention, and response inhibition. The degree of behavioural impairment on motor impulsivity (prolonged response inhibition Stop-Signal Reaction Time) strongly correlated with the B-SIT score. Our study is the first to indicate a shared OFC pathological neural substrate underlying olfactory identification impairment, impulsivity, and OCD. Deficits in visual memory, executive functions and attention further indicate that regions outside of the orbitofronto-striatal loop may be involved in this disorder. Such results may help delineate the clinical complexity of OCD and support more targeted investigations and interventions. In this regard, research on the potential diagnostic utility of olfactory identification deficits in the assessment of OCD would certainly be useful.
[show abstract][hide abstract] ABSTRACT: OBJECTIVES: To review our current knowledge of the aetiopathogenesis of Vogt-Koyanagi-Harada syndrome, including viral infection, genetic factors and immunomediated mechanisms, and to discuss pathogenesis and its relevance to pharmacotherapy. SYSTEMATIC REVIEW METHODOLOGY: Relevant publications from 1965 to 2012 on the aetiopathogenesis and pharmacotherapy of VKHS were analysed. RESULTS AND CONCLUSION: Vogt-Koyanagi-Harada syndrome (VKHS) is a rare multisystemic autoimmune disease that affects tissues containing melanin, including the eye, inner ear, meninges, and skin. The disease is characterised by bilateral uveitis associated with a varying constellation of auditory, neurological and cutaneous manifestations. The disease occurs more frequently among people with darker skin pigmentation. Asians, Native Americans, and Hispanics are most frequently affected. It predominates in patients aged between 20 and 50 years, and females are affected more frequently, with a female:male ratio of 2:1 . The classic clinical course is characterised by bilateral panuveitis, hypoacusis, and meningitis, in addition to cutaneous involvement with poliosis, vitiligo, and alopecia. Although the exact cause of VKH disease remains unknown, it is thought to be a T-cell-mediated autoimmune process directed against melanocytes. VKHS classically begins with vague systemic symptoms suggestive of a viral infection, although a clear association between a specific viral agent and the disease has not been established. Genetic factors may play an important role in the loss of self-tolerance in VKHS. The HLA-DRB1*0405 allele is the main susceptibility allele for VKHS. Early and aggressive systemic corticosteroids are still the primary initial therapy for VKHS. Ocular complications may require an intravitreous injection of corticosteroids. Despite proper treatment with steroids, a number of patients experience recurrent attacks or steroid-associated complications. Thus, non steroid immunomodulatory therapy (IMT) has become necessary for the treatment of VKHS.
[show abstract][hide abstract] ABSTRACT: Objective
To assess the feasibility of intracorporeal lithotripsy with holmium YAG laser under sialoendoscopic guidance for sialolithiasis of Wharton's duct.Study DesignCase series with planned data collection.SettingTertiary referral university hospital.Methods
This study was conducted on 16 patients with sialolithiasis of Wharton's duct. Diagnosis was confirmed at ultrasound examination. Patients with stones ranging from 5 to 8 mm in diameter were enrolled in the study. The selected patients underwent intracorporeal lithotripsy with holmium Yag laser under endoscopic control. Debris was removed using sialoendoscopic forceps or a wire basket during the same procedure. After a 3-month follow-up, radiological tests were rerun.ResultsStone fragmentation was possible in all cases. All patients experienced a regular postoperative course. Postoperative ultrasound examinations revealed residual stones in 3 patients, 1 of whom was asymptomatic. Three patients complained of residual symptoms after 3 months of follow-up. These patients were treated successfully during a second sialoendoscopic procedure.Conclusions
In our experience, endoscopic laser lithotripsy was proved to be a feasible technique for Wharton's duct lithiasis in clinical practice.
Otolaryngology Head and Neck Surgery 03/2013; · 1.63 Impact Factor
[show abstract][hide abstract] ABSTRACT: The aim of this prospective study is to establish whether ductoplasty is necessary to repair the Wharton's duct after a combined endoscopic and external approach to remove large submandibular gland stones or if simple suturing of the oral floor mucosa after stent placement may be sufficient to achieve proper duct healing. Ten patients were enrolled. Ductoplasty was performed in 6 cases, whereas in 4 cases, only the mucosa of the oral floor was sutured. The stent was removed about 3 weeks after surgery. Sialoliths were completely removed in all cases. During follow-up, patient symptom evaluation, ultrasound, and physical examination showed no signs of recurrence or complications. In our limited experience, ductoplasty after the combined approach was not necessary. After stent placement, the mere suture of the oral mucosa overlying the damaged ductal wall allowed a correct recanalization of the ductal lumen as commonly observed after careful ductoplasty.
Otolaryngology Head and Neck Surgery 02/2013; · 1.63 Impact Factor
[show abstract][hide abstract] ABSTRACT: A 69-year-old woman with mucoepidermoid carcinoma (MEC) of the tongue base came under our observation complaining of repeated episodes of haemoptysis. Mucoepidermoid carcinoma of the tongue base gives rise to a rather vague and aspecific symptomatology. Early symptoms include foreign body sensation in the oral cavity, undefined paraesthesia, and sialorrhoea. With the progression of disease, dysphagia, otalgia, and painful swallowing are usually referred. We report a case of mucoepidermoid carcinoma of the tongue base mimicking an ectopic thyroid.
Case reports in otolaryngology. 01/2013; 2013:925630.
[show abstract][hide abstract] ABSTRACT: Objective
The aim of this study is to evaluate the sensitivity parameters of the percentage of time the pH is <4 and >7, as well as the total number of laryngopharyngeal reflux episodes in 24 hours, in patients with suspected laryngopharyngeal reflux disease.Study DesignRetrospective controlled study.SettingUniversity hospital.Subjects and Methods
The study was conducted on 46 patients with laryngopharyngeal reflux disease and 58 healthy controls. Patients and controls underwent 24 hours of dual-probe pH monitoring of the distal and cervical esophagus. Patients completed a Reflux Symptom Index questionnaire and underwent esophageal manometry. Data concerning the percentage of time the pH was <4 and >7 and the number of reflux episodes registered at the cervical esophagus were collected and evaluated.ResultsThe percentage of time the pH is <4 and the number of laryngopharyngeal reflux episodes seem to be a reliable diagnostic laryngopharyngeal reflux criterion reaching satisfactory sensitivity (81% and 83%, respectively). Although the pH >7 parameter appeared statistically different between the 2 groups (P < .001), the sensitivity of the test appeared to be poor (55%).Conclusion
Our study demonstrates the importance of the absolute number of laryngopharyngeal reflux episodes in 24 hours in the diagnosis of patients with suspected laryngopharyngeal reflux, proposing it as a new diagnostic criterion.
Otolaryngology Head and Neck Surgery 11/2012; · 1.63 Impact Factor
[show abstract][hide abstract] ABSTRACT: OBJECTIVES: The objective of our study was to review our current knowledge of the aetiopathogenesis of Cogan's syndrome, including viral infection and autoimmunity, and to discuss disease pathogenesis with relevance to pharmacotherapy. SYSTEMATIC REVIEW METHODOLOGY: Relevant publications on the aetiopathogenesis and pharmacotherapy of Cogan's syndrome from 1945 to 2012 were analysed. RESULTS AND CONCLUSIONS: Cogan's syndrome is a rare autoimmune vasculitis, and its pathogenesis is unknown. Infection, but primarily autoimmunity, may play contributing roles in the pathogenesis of this disease. It is characterised by ocular and audiovestibular symptoms similar to those of Meniere's syndrome. Approximately 70% of patients have systemic disease, of which vasculitis is considered the pathological mechanism. The immunologic theory is based on the release of auto-antibodies against corneal, inner ear and endothelial antigens, and of anti-nuclear cytoplasmic auto-antibodies (ANCA). Corticosteroids are the first line of treatment, and multiple immunosuppressive drugs have been tried with varying degrees of success. Tumour necrosis factor (TNF)-alpha blockers are a category of immunosuppressive agents representing a recent novel therapeutic option in Cogan's syndrome.
[show abstract][hide abstract] ABSTRACT: OBJECTIVES: To review our current knowledge of the etiopathogenesis of Bell's palsy, including viral infection or autoimmunity, and to discuss disease pathogenesis with respect to pharmacotherapy. SYSTEMATIC REVIEW METHODOLOGY: Relevant publications on the etiopathogenesis, clinical presentation, diagnosis and histopathology of Bell's palsy from 1975 to 2012 were analysed. RESULTS AND CONCLUSIONS: Bell's palsy is an idiopathic peripheral nerve palsy involving the facial nerve. It accounts for 60 to 75% of all cases of unilateral facial paralysis. The annual incidence of Bell's palsy is 15 to 30 per 100,000 people. The peak incidence occurs between the second and fourth decades (15 to 45years). The aetiology of Bell's palsy is unknown but viral infection or autoimmune disease has been postulated as possible pathomechanisms. Bell's palsy may be caused when latent herpes viruses (herpes simplex, herpes zoster) are reactivated from cranial nerve ganglia. A cell-mediated autoimmune mechanism against a myelin basic protein has been suggested for the pathogenesis of Bell's palsy. Bell's palsy may be an autoimmune demyelinating cranial neuritis, and in most cases, it is a mononeuritic variant of Guillain-Barré syndrome, a neurologic disorder with recognised cell-mediated immunity against peripheral nerve myelin antigens. In Bell's palsy and GBS, a viral infection or the reactivation of a latent virus may provoke an autoimmune reaction against peripheral nerve myelin components, leading to the demyelination of cranial nerves, especially the facial nerve. Given the safety profile of acyclovir, valacyclovir, and short-course oral corticosteroids, patients who present within three days of the onset of symptoms should be offered combination therapy. However it seems logical that in fact, steroids exert their beneficial effect via immunosuppressive action, as is the case in some other autoimmune disorders. It is to be hoped that (monoclonal) antibodies and/or T-cell immunotherapy might provide more specific treatment guidelines in the management of Bell's palsy.
[show abstract][hide abstract] ABSTRACT: Laryngotracheal stenosis is a complex condition that usually requires multiple procedures to restore physiological respiration. The aim of this study was to evaluate the percentage of decannulation compared to different or multiple surgical treatments. We retrospectively reviewed the charts of 70 patients treated between 1990 and 2005 for laryngotracheal stenosis of various aetiology: iatrogenic stenosis (n = 55), post-traumatic stenosis (n = 11) or other causes (autoimmune disease, n = 3; diphtheria, n = 1). In order to maintain laryngotracheal patency, a Montgomery Safe-T tube was used in all patients as a single dilation treatment or associated with endoscopic and/or open-neck surgery. Fifty-four of the 70 patients (77.1%) were eventually decannulated; 39 of these (72.2%) underwent 3 or fewer surgical procedures, showing a significant difference compared to patients who underwent more than 3 surgeries (p = 0.00002). A total of 257 surgeries were performed. Only seven of 54 patients (13%) were decannulated after more than 5 surgical procedures. Patients over 60 years of age and with a higher grade of stenosis showed a significantly lower success rate (p = 0.0017 and p = 0.007, respectively). There was no significant correlation between the rate of decannulation and gender, aetiology, site of stenosis or surgery. Patients undergoing dilation for laryngotracheal stenosis usually require multiple procedures. The T tube plays an important role in the treatment of this pathology. However, if the tracheostomy is not removed within 3 surgical interventions, the odds of decannulating the patient decrease significantly, and additional surgeries may be of questionable therapeutic benefit.
Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 04/2012; 32(3):182-8. · 0.79 Impact Factor
[show abstract][hide abstract] ABSTRACT: The aim of the study was to evaluate the oncologic outcome of our series of advanced laryngeal squamous cell carcinomas, primarily treated by supracricoid laryngectomy with cricohyoidopexy or total laryngectomy, to compare the two therapeutic modalities.
Retrospective controlled study.
We retrospectively reviewed the medical files, operative charts, and pathology reports of 83 patients who underwent total laryngectomy or supracricoid laryngectomy with cricohyoidopexy between February 1999 and March 2009. We only included cases in which both surgical treatments were feasible. Endpoints included local control, locoregional control, overall survival, and disease-specific survival.
When we stratified the patients according to T stage, no statistically significant differences emerged in terms of overall and disease-specific survival. When we compared total laryngectomy to cricohyoidopexy in N1 patients, 3-year overall survival and disease-specific survival differences were statistically relevant (P = .022 and P = .030, respectively).
Total laryngectomy warranted better results in term of overall and disease-specific survival, although the differences were not statistically significant. Local and locoregional control in the two treatment groups were overlapping, showing that cricohyoidopexy (when technically feasible) could be a valid surgical option in selected advanced laryngeal squamous cell carcinoma.
The Laryngoscope 02/2012; 122(4):826-33. · 1.98 Impact Factor
[show abstract][hide abstract] ABSTRACT: We evaluated the efficacy of endoscopic techniques employed in the management of cervical esophageal and hypopharyngeal strictures.
A series of 45 patients with cervical esophageal (35) and/or hypopharyngeal strictures (10) were included. Twenty-five patients (55.6%) with neoplastic strictures were treated for palliation alone. The stenosis was related to radiotherapy in 11 patients (24.4%) and to postsurgical complications in 9 (20%). A group of 23 patients was treated with dilation alone (group 1). A second group included 22 patients treated with insertion of a self-expandable stent after failure of dilation treatment (group 2). The swallowing test data, clinical notes, and surgical reports were reviewed.
All of the patients showed some degree of relief of dysphagia. In group 1, 19 of the 23 patients required multiple dilation treatments to maintain normal deglutition. In group 2, 7 of the 22 patients recovered regular oral feeding after stent placement, 10 patients reported pain and foreign body sensation, 2 patients reported pain so severe that stent removal was required, and 3 patients experienced stent migration. All but 3 of the 25 patients with inoperable tumors died during follow-up, but no patients with benign stenosis died.
The two groups showed comparable functional results. Dilation often requires multiple procedures, but is usually well tolerated. Placement of self-expandable stents is effective, but is generally less well tolerated.
The Annals of otology, rhinology, and laryngology 02/2012; 121(2):104-9. · 1.21 Impact Factor
[show abstract][hide abstract] ABSTRACT: OBJECTIVES: To review our current knowledge of the pathogenesis of Meniere's disease, including viral infection and immune system-mediated mechanisms, and to discuss the pathogenesis as it relates to pharmacotherapy. SYSTEMATIC REVIEW METHODOLOGY: Relevant publications on the aetiopathogenesis, molecular biology, genetics and histopathology of Meniere's disease from 1861 to 2011 were analysed. RESULTS AND CONCLUSIONS: Meniere's disease is characterised by intermittent episodes of vertigo, fluctuating sensorineural hearing loss, tinnitus, and aural pressure. The aetiology and pathogenesis remain unknown. Proposed theories of causation include viral infections and immune system-mediated mechanisms. The immune response in Meniere's disease is focused on inner ear antigens. Approximately one-third of Meniere's disease cases seem to be of an autoimmune origin although the immunological mechanisms involved are not clear. The diagnosis of autoimmune inner ear disease is based either on clinical criteria or on a positive response to steroids. The antiviral approach has virtually eliminated the use of various surgical methods used in the past. Steroid responsiveness is high, and with prompt treatment, inner ear damage may be reversible. The administration of etanercept improves or stabilises symptoms in treated patients. Treatment of antiphospholipid syndrome can be directed toward preventing thromboembolic events by using antithrombotic medications. Only warfarin has been shown to be effective. Gene therapy can be used to transfer genetic material into inner ear cells using viral vectors and to protect, rescue, and even regenerate hair cells of the inner ear.
[show abstract][hide abstract] ABSTRACT: A parotid fistula is a rare and extremely unpleasant condition. In this paper, we present the case of a 53-year-old woman with a diagnosis of posttraumatic fistula of the parotid gland. After exclusion of other therapeutic alternatives, it was decided to use transdermal scopolamine patches at sustained release (Scopoderm TTS). This technique consists in the application every three days of a patch with 1.5 mg of scopolamine in the area of the mastoid apophysis; the patch releases a dose of 0.5 mg of the active substance over each 24-hour period. The patient underwent periodic clinical followup over a period of three years, achieving satisfactory results with no significant adverse effects.
[show abstract][hide abstract] ABSTRACT: Our goal was to describe a total cricoidectomy, a laryngeal-preserving procedure for the treatment of low-grade chondrosarcomas of the larynx. These extremely rare cartilaginous tumors arise in the cricoid cartilage in most cases. Although these are slow-growing and rarely metastasizing tumors, large chondrosarcomas of cricoid cartilage are generally treated with total laryngectomy. An oncologically radical but function-preserving approach would therefore be preferable.
Three consecutive patients with low-grade chondrosarcomas of the larynx underwent total cricoidectomy from 1996 to 2004. An end-to-end anastomosis between the remaining larynx and the trachea was performed to restore the continuity of airways. In all cases the laryngeal lumen was stented using a Montgomery T-tube. Oncologic and functional results were observed during at least 6 years of follow-up.
No evidence of tumor recurrence was detected during follow-up. One month after surgery, all patients were able to tolerate a soft diet and to speak satisfactorily. One patient was ultimately decannulated, and two patients still have a tracheostomy. However, even nondecannulated patients were able to keep the tracheostoma closed for most of the time, maintaining good phonatory and swallowing functions.
Total cricoidectomy with thyrotracheopexy may avoid the need for total laryngectomy in low-grade chondrosarcomas of the cricoid cartilage.
The Laryngoscope 11/2011; 121(11):2375-80. · 1.98 Impact Factor
[show abstract][hide abstract] ABSTRACT: OBJECTIVES: To review our current knowledge of the pathogenesis of sudden sensorineural hearing loss, including viral infection, vascular occlusion and immune system-mediated mechanisms, and to discuss the pathogenesis as it relates to pharmacotherapy. SYSTEMATIC REVIEW METHODOLOGY: Relevant publications on the pathogenesis of sudden sensorineural hearing loss from 1944 to 2010 were analysed. RESULTS AND CONCLUSIONS: Sudden sensorineural hearing loss is defined as hearing loss of 30 dB in three sequential frequencies over 3 days or less. It can be an isolated symptom or the presenting symptom of a systemic disease. The aetiology and pathogenesis remain unknown. Detailed investigation typically reveals a specific cause in about 10% of patients. Proposed theories of causation include viral infections, vascular occlusion and immune system-mediated mechanisms. A variety of therapies have been proposed based on the various proposed aetiologies.