Acta Otorhinolaryngologica Italica最新文献

Objectives: To investigate the expression of hypoxia-inducible factor-1α (HIF-1α) in patients with refractory sudden sensorineural hearing loss (SSNHL).

Material and methods: Thirty patients with refractory SSNHL were treated with intratympanic methylprednisolone perfusion (IMP) for 10 days. Expression of HIF-1α and histone deacetylase 2 (HDAC2) was evaluated in peripheral blood mononuclear cells (PBMCs) and in vitro.

Results: Significant hearing improvement (≥ 15 dB) was observed in 16 patients [IMP glucocorticoid sensitive (GCS) group], while 14 patients had no therapeautic hearing recovery [IMP GC resistance (GCR) group]. The expression of HDAC2 decreased and HIF-1a increased in all refractory SSNHL patients before IMP. The expression of HDAC2 and HIF-1α after IMP was significantly changed in the GCS group, but not in the GCR group. The same expression profile was also observed in House Ear Institute-organ of Corti-1 (HEI-OC1) cells exposed to oxidative stress (OS). The results of gene manipulation experiments indicate that HIF-1α up-regulation significantly reduced HDAC2 expression in HEI-OC1 cells, especially under conditions of OS.

Conclusions: This study suggests that HIF-1α activation inhibits HDAC2 expression, causing glucocorticoid resistance in refractory SSNHL. HIF-1α might serve as a potential biomarker to predict prognosis of refractory SSNHL.

Objectives: The purpose of this study is to present the long-term functional swallowing outcomes of various surgical approaches to oral tongue/floor of mouth squamous cell carcinoma (OTFOMSCC) according to a modular and compartment-based concept previously described elsewhere.

Methods: A retrospective study was conducted on patients undergoing surgery for OTFOMSCC from January 2017 to April 2023 in the Department of Otorhinolaryngology at the Hospital of Bolzano. Functional swallowing outcomes and quality of life (QoL) were assessed through the administration of a scale and questionnaires between 6 months and 1 year postoperatively or after the end of adjuvant therapy, stratifying the results according to the surgical technique used.

Results: A total of 92 patients with OTFOMSCC were enrolled: 44 patients underwent transoral anatomically guided surgery (TAGS) for early-stage tumours, and 48 underwent major surgery for advanced stages. Among the latter 48 patients: 35 underwent compartment tongue surgery (CTS), 3 underwent extended glossectomies (EG) Type A, 6 underwent EG Type B, and 4 underwent EG Type C. After TAGS, all patients resumed oral feeding for all consistencies. In the CTS group, only one patient faced challenges with pure liquids, yet all achieved the target of consuming a semisolid and semiliquid diet. EG exhibited a noticeable decline in performance from Type A to total glossectomy (Type C).

Conclusions: Following an anatomically-guided approach to the resection of OTFOMSCC allows the surgery to be modulated on the structures involved by the tumour, thus achieving optimal oncological results, while maintaining the possibility to predict functional outcomes and postoperative QoL.

Objective: We report the management of recurrent respiratory papillomatosis (RRP) employing a protocol that includes both office-based (OB) and general anaesthesia (GA) procedures. Quality of life (QoL) outcomes in the OB cohort were compared to those obtained from an historical cohort treated only under GA.

Methods: Patients affected by RRP from 2019 until 2023 ("new protocol") and from 2012 to 2019 ("historical protocol") were enrolled. In both groups the Derkay site score (DSS) was calculated. In patients adhering to the new protocol, questionnaires measuring QoL were prospectively administered (voice handicap hindex-10 [VHI-10] along with a specific questionnaire to measure the tolerance to the OB procedures). A cost analysis was also performed.

Results: In all, 35 patients composed the new protocol cohort and 13 the historical. In the first group, patients underwent a median of 4 treatments. At 2 years, 68% of patients were treated exclusively in the office. Overall, for the new protocol, median DSS and VHI-10 after one year were both significantly lower than those at baseline [2 vs 4 and 3 vs 14, respectively; p < 0.001]. No differences were found between the new and the historical protocol cohorts considering DSS over time.

Conclusions: Treatment of RRP may be conducted successfully in an office-based setting reducing healthcare costs.

Objective: This study evaluated the expression of TIM-3 and its influence on macrophage polarisation in recalcitrant chronic rhinosinusitis with nasal polyps (CRSwNP).

Methods: We detected TIM-3 expression in serum and tissue samples of healthy controls (HC), primary CRSwNP, and patients with recurrent CRSwNP. Macrophage markers were detected among three groups, and their correlations with TIM-3 levels were examined. Macrophages from circulating blood were collected and used to examine the impact of TIM-3 on polarisation in vitro.

Results: TIM-3 levels were enhanced in the CRSwNP group compared to the HC group. Tissue immunofluorescence revealed elevated TIM-3 expression in patients with CRSwNP, and patients with multiple recurrences exhibited higher TIM-3 levels compared to their first recurrence and baseline levels. Tissue CD163 and CD206 levels were higher in recurrent CRSwNP in comparison with primary cases and HCs, and had a positive correlation with TIM-3 levels. TIM-3 overexpression promoted M2 polarisation and enhanced TGF-β1 and IL-10 secretion.

Conclusions: TIM-3 expression was enhanced in patients with CRSwNP, especially in those undergoing revision surgeries. TIM-3 may be a novel biomarker for recalcitrant CRSwNP. TIM-3-driven M2 polarisation might be involved in the mechanisms of recurrent CRSwNP.

Objective: For frontal sinus inverted papilloma (FSIP) management, an endoscopic endonasal approach (EEA) can be combined (or not) with an external approach by an osteoplastic flap (OPF) or with a more conservative open approach. The present study aims to describe our experience in the management of FSIP, focusing on disease-related and anatomical features influencing outcomes and recurrence.

Methods: This case series of FSIP investigated anatomical and disease-related predictors of recurrence associated with EEA or a combined EEA-OPF approach. A systematic review was also performed, selecting publications on IP with the insertion point in the frontal sinus or frontal recess.

Results: Among 30 patients included, 18 underwent EEA, while 12 received a combined EEA-OPF approach. During a median follow-up of 37 months, the frontal sinus was cleared of IP in all cases except 2 in the EEA group, who presented a complex posterior wall shape of the frontal sinus. From the systematic review, a combined EEA-OPF approach was associated with a lower risk of recurrence.

Conclusions: A correct indication for a combined EEA-OPF approach is paramount and should integrate all disease-related and anatomical features, including posterior wall shape.

Objective: The study aimed to identify factors affecting the management and prognosis of iatrogenic cervical oesophageal and hypopharyngeal perforations (iCEHPs).

Methods: We retrospectively analysed 24 patients treated for iCEHP between 2004 and 2021 at a tertiary university medical centre. Data on demographics, clinical features, imaging, management and outcomes were collected. Factors associated with primary management and patient outcome were assessed.

Results: The most common management approach was surgical neck exploration (15 patients, 62.5%). Surgical management was used in 93% of uncontained perforations compared to 11% of contained perforations (p < 0.001). Surgically-treated patients had higher levels of C-reactive protein (CRP) than conservatively-treated patients (median, 18.3 vs 4.8 mg/dL; p = 0.001). Delayed diagnosis (≥ 24 hours) was associated with increased mortality (100 vs 5%; p = 0.011). The mortality rate was significantly higher in patients who had a history of neck irradiation than in patients who did not (67 vs 5%; p = 0.032).

Conclusions: Early diagnosis of iCEHP improves outcomes. The appropriate management should be carefully selected on the basis of CRP level and imaging findings. Prior neck radiation is a poor prognostic factor.

Objective: Skull base anatomy around the internal carotid artery (ICA) is extremely complex. Among anatomical landmarks studied, the vidian canal has been thoroughly evaluated, unlike the vidian nerve (VN). Our aim is to evaluate the VN-ICA relationships, and understand their role in terms of surgical planning.

Methods: Fifty MRI examinations of 100 healthy petro-spheno-clival regions were reviewed in order to evaluate the relationship between the vidian nerve axis (VNA) and the petrous ICA. Twenty-seven cases of expanded endonasal approaches to petrous apex region were evaluated to check the VN-ICA relationship intraoperatively.

Results: MRI evaluations showed that, in 23% of cases, the VNA was below the edge of the ICA, in 45% it was at the edge of the ICA and in 32% it ended up above the edge of the ICA. Surgically speaking, in 9 of 28 petrous apex approaches, the VN ended above the inferior edge of the petrous carotid.

Conclusions: MRI evaluation adds useful information in planning the surgical approach to petro-spheno-clival regions, even if the identification of VNA, in these cases, may not be radiologically possible. Surgical experience confirms the importance of VN identification in guiding the surgeon in complex cases, and also outline the possible risks of relying only on this landmark.