Acta Otorhinolaryngologica Italica最新文献

Objective: Over the past two decades there has been a strategic shift in treating laryngeal cancer, with an increasing emphasis on preserving the anatomical structure and function of the larynx, even in cases of intermediate or advanced stages of disease. Open partial horizontal laryngectomies (OPHL) are widely adopted to spare the physiological functions of the larynx while achieving good oncological control. Positive, close or narrow surgical margins remain a critical prognostic factor, with their impact varying by tumour location and laryngeal subsite. This review examines the influence of positive margins on survival and the potential need for adjuvant treatments to optimise functional and oncological outcomes.

Methods: This study adhered to PRISMA guidelines. Using the PICOS framework, it included studies on adults with laryngeal squamous cell carcinoma treated by OPHL, focusing on survival and local control outcomes. A systematic search of PubMed, EMBASE, and Cochrane databases from 2000 to 2023 was conducted and eligible studies were selected based on comprehensive inclusion criteria and screening of references.

Results: The initial search yielded 675 articles from PubMed, 799 from EMBASE, and 33 from the Cochrane Library. After exclusions and duplicate removal, 57 full-text articles were reviewed, with 8 included for qualitative analysis and 7 for quantitative analysis. A total of 2,715 patients (age range, 16-87 years) were recruited across studies spanning from 2001 to 2021, all of which were retrospective. Among patients, 284 (10%) received neoadjuvant treatment and 627 (23%) underwent adjuvant therapy for positive margins, lymph node involvement and adverse pathological features. Seven studies assessed the association between margin status and recurrence, showing that close/positive margins significantly increased recurrence risk (OR 2.77, 95% CI 1.99-3.87, p < 0.01), with no publication bias detected.

Conclusions: This review highlights the challenges in defining and managing resection margins in OPHL for laryngeal cancer. While positive or close margins increase the risk of local recurrence, their effect on overall survival is unclear, emphasising the need for standardised protocols and individualised, multidisciplinary treatment planning.

Objective: In oropharyngeal squamous cell carcinoma (OPSCC), proper definition of surgical margins may have substantial impact on oncologic outcomes. Minimally-invasive techniques prioritise reduced morbidity, yet open approaches remain significant due to limited large-scale evidence comparing their outcomes with transoral methods. The purpose of the present systematic review was to assess the incidence of positive margins in OPSCC management based on surgical approach (open vs transoral) and the subsequent risk of additional treatments.

Methods: Medical databases were searched including PubMed, Scopus, EMBASE, and Cochrane Library from January 2000 to August 2024. Data analysis was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, and the quality of studies was evaluated using the Newcastle-Ottawa Scale.

Results: Four studies, including 305 patients (126 treated by an open approach, and 179 by transoral surgery), were qualitatively analysed. No significant difference was found in the rates of positive margins (p = 0.422) or need for adjuvant therapy (p = 0.368) between the two approaches. It was not feasible to conduct a meta-analysis due to significant inconsistencies in the reporting of data across the studies included.

Conclusions: Transoral approach is recommended for early-stage OPSCC when adequate exposure is achievable, although its impact on positive surgical margins remains unclear. The management of close or positive margins remains debated due to the oropharyngeal unique anatomy and function, with no clear de-intensification protocol established.

Objective: Cochlear implant (CI) is a well-established treatment for children with sensorineural hearing loss without benefit from hearing aids. The Italian guidelines date back 15 years; given the expansion of indications for CI (including single side deafness and asymmetrical hearing loss) it became necessary to establish updated guidelines.

Methods: Thirteen experts and 2 patient representatives selected the key questions and drew up recommendations. The document was developed following the GRADE methodology. The methodological team of the Mario Negri Pharmacological Research Institute performed systematic reviews for each question and supported the overall process.

Results: Four key questions were identified and recommendation formulated, with subgroups and implementation considerations.

Conclusions: Though the systematic research of scientific literature found a scarcity of randomised trials and an overall poor conduct and reporting quality of primary studies and systematic reviews, conditional recommendations in favour of CI have been formulated for different subgroups of children. Further studies should enrol a larger number of participants and use consistent instruments to evaluate hearing outcomes, in order to increase comparability of results and data pooling through meta-analysis.

Objective: The objective of this study was to analyse the aetiology, clinical presentations, histopathology and microbiological aspects of fungal rhinosinusitis (FRS) in patients undergoing endoscopic surgery.

Methods: The descriptive study was carried out over a 4-year period in two Serbian ENT Clinics and included patients with sinonasal pathology who underwent endoscopic surgery.

Results: The study included 26 patients. The most common forms of FRS treated by endoscopic sinus surgery was allergic FRS (AFRS). The fungus identification rate varied between entities, and was 72.2% in AFRS and 33.3% in fungal ball specimens. The common species seen in AFRS isolates were Cladosporium spp. (38.5% of isolated) and dematiaceous molds in the same percentage, while the remainder of the cultures were hyaline moulds. CT scan can be very helpful in diagnosing FRS and sometimes even in differentiating between different entities. Treatment of FRS should be tailored for each entity. Postoperative medical treatment in AFRS should consider potential advancements described in the literature.

Conclusions: This study emphasises the need to combine all types of clinical, radiology, pathohistological and microbiological methods to obtain the best diagnostic and treatment strategies and should be the basis for further research.

Objectives: Adenoidectomy performed as day surgery is a safe and cost-effective procedure, but patients may be occasionally admitted overnight due to the need for extended care. This study investigates the unplanned admission rate following day surgery adenoidectomy in children.

Methods: Data from 3,396 children who underwent adenoidectomy from 2010 to 2023 were retrospectively collected in a tertiary centre. Inclusion criteria were age > 2 years and ASA score I-II. The study focused on evaluating factors such as age, gender, duration of surgery, surgeon's experience, adverse events and multiple surgeries. Univariate and multivariate analysis were performed, and ROC curves were built for continuous variables.

Results: The unplanned admission rate was 2.3%, with postoperative nausea/vomiting being the most common complication. Respiratory complications were notably low. Factors associated with unplanned admission at multivariate analysis included the end time of surgery (p < 0.001), surgical duration (p = 0.001) and surgeon's experience (p < 0.001).

Conclusions: This study confirms the safety and feasibility of adenoidectomy as day surgery in a tertiary centre, with a low unplanned admission rate and infrequent serious complications. Further studies are needed to generalise these findings to different settings and populations.

Objectives: Genetic polymorphisms in bitter taste receptor 2 member 38 (TAS2R38), expressed in the cilia of sinonasal epithelial cells, have been proposed to be contributors to chronic rhinosinusitis (CRS).

Methods: We assessed the impact of the genetically determined TAS2R38 structure on predisposition to CRS and correlated the expression of the TAS2R38 with haplotypes. 86 patients (60 CRS patients, 26 controls) undergoing nasal surgery were enrolled. PCR to identify single nucleotide polymorphisms in genes encoding TAS2R38 were performed. TAS2R38 expression in sinus mucosa tissues was assessed by immunohistochemistry.

Results: Among CRS patients, the protective genotype PAV/PAV of the TAS2R38 was observed with the lowest frequency. Immunohistochemistry displayed significant overexpression of TAS2R38 in patients with CRS and in those with a non-functional AVI/AVI genotype. Under inflammatory conditions, TAS2R38 was found to translocate from the cell membrane.

Conclusions: Genetically determined TAS2R38 polymorphisms may influence susceptibility to CRS. The AVI haplotype seems to be an independent risk factor for CRS. Additionally, TAS2Rs and related signalling pathways might create a unique group of therapeutic targets in CRS.

Objective: This study aims to show preliminary results of the validation the Comparative pre/post-treatment Self-Assessment of Dysphonia (CSAD) questionnaire in assessing vocal quality and phonatory fatigue following treatment for dysphonia.

Methods: A retrospective analysis was conducted on 51 patients who underwent phonosurgery for various vocal diseases. Patients completed the CSAD questionnaire post-treatment, alongside the Voice Handicap Index (VHI-10) administered before and after treatment. Correlation analyses were performed between CSAD scores and differences in pre- and post-treatment VHI-10 scores.

Results: The CSAD demonstrated simplicity and ease of interpretation, requiring no pre-treatment administration. Despite its streamlined nature, it exhibited a satisfactory level of correlation with post-treatment VHI-10 scores, indicating its effectiveness in evaluating treatment outcomes for dysphonia.

Conclusions: The CSAD emerges as a simple yet effective tool for self-assessing vocal quality and phonatory fatigue after treatment in patients with dysphonia. Its straightforwardness and post-treatment administration make it a manageable and valuable addition to clinical practice, streamlining assessment processes without compromising accuracy.

Objective: Malnutrition is common among patients undergoing surgery for head and neck cancer (HNC), leading to higher postoperative complications and mortality rates. Immunonutritional intervention has potential in reducing these risks by enhancing immune function and aiding wound healing.

Methods: A systematic review and meta-analysis were conducted according to PRISMA guidelines. Nineteen randomised controlled trials involving 1,196 participants undergoing surgery for HNC were included. Studies comparing immunonutrition with standard care were analysed for outcomes including fistula formation, wound infections, other infections, and length of hospital stay.

Results: Immunonutrition significantly reduced postoperative fistulas and shortened hospital stays compared to standard care. The impact on wound and systemic infections was inconclusive. Immunonutrition was generally well-tolerated, with no significant increase in adverse events.

Conclusions: These findings highlight the potential benefits of immunonutrition in improving postoperative outcomes for patients with HNC. However, the variability in study outcomes and limitations in quality call for further research to clarify the specific efficacy, long-term effects, and cost-effectiveness of immunonutrition in this context.

Objective: This study aimed to investigate the role of m6A-related long non-coding RNAs (lncRNAs) in the prognosis and tumour microenvironment of head and neck squamous cell carcinoma (HNSCC).

Methods: 497 samples from The Cancer Genome Atlas were analysed to identify m6A-related lncRNAs via correlation models. Tripartite regression models, Kaplan-Meier analysis and nomograms were then utilised to assess the prognostic significance of these lncRNAs. Tumour mutation burden and immune cell infiltration analyses were also performed. Moreover, m6A-related lncRNAs expression and relation with IGF2BP2 were confirmed by RT-qPCR.

Results: The risk model revealed that high-risk scores predicted poorer survival outcomes. The area under ROC curves for predicting 1-, 3-, 5-year survival in the training set were 0.70, 0.68, and 0.64, respectively. Seven key m6A-related lncRNAs showed associations with immune checkpoint molecules, especially CTLA4 and PD-1. Finally, we found that knockdown of TUG1 repressed the expression of IGF2BP2.

Conclusions: Our results suggest that the m6A-related lncRNA risk model has potential clinical utility in predicting prognosis and immunotherapeutic responses in patients with HNSCC. Identification of candidate compounds for immunotherapy further emphasises the model's relevance in guiding treatment decisions for HNSCC.