ENT Unit

Independencia, Argentina
Independencia, Argentina
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McClurg S.W.,ENT Unit | Wakely P.E.,Jr
Ear, nose, & throat journal | Year: 2015

Mucosal neuromas of the larynx in the setting of multiple endocrine neoplasia type 2B (MEN-2B) are extremely rare; to the best of our knowledge, only 2 other cases have been previously reported in the world literature. We describe a new case, which occurred in a 30-year old woman who presented with dysphagia, dysphonia, and cough. On examination, she was found to have multiple laryngeal mucosal neuromas throughout the glottis and supraglottis. She underwent surgical resection of these lesions with resolution of her symptoms.

Zanoletti E.,Padua General Hospital | Marioni G.,University of Padua | Lionello M.,University of Padua | Giacomelli L.,University of Padua | And 3 more authors.
Laryngoscope | Year: 2014

Objectives/Hypothesis Temporal bone squamous cell carcinoma (SCC) is an uncommon malignancy accounting for less than 0.2% of head and neck cancers. Despite advances in its early diagnosis, skull base microsurgery, radiotherapy, and integrated treatments, prognosis in advanced SCCs remains dismal. The present study aimed to analyze the clinicopathological variables potentially influencing outcome in a series of temporal bone SCCs. Study Design The prognosis of 41 patients with temporal bone SCC was assessed retrospectively using univariate and multivariate statistical approaches. Patients and Methods Twenty-two women and 19 men consecutively operated for primary temporal bone SCC with a curative intent at a tertiary referral center between 1980 and 2008. Results On univariate analysis, cT stage correlated with disease-free survival in months (DFS) (P=0.037), and pT stage correlated with recurrence rate (P = 0.038), DFS (P = 0.013), and disease-specific survival (DSS) (P = 0.025). Lymph node status (cN0 or pN0 vs. pN+) was associated with DFS (P = 0.025). SCC grading correlated significantly with recurrence rate (P = 0.005), DFS (P = 0.004), and DSS (P = 0.0036). Dura mater involvement was significantly associated with a higher recurrence rate (P = 0.001), a shorter DFS (P = 0.00001), and a lower DSS (P = 0.0001). On multivariate analysis, only dura mater involvement (P = 0.001) and N status (P = 0.012) remained independently prognostic of DFS. Conclusion Recurrences occurred despite obtaining block resections according to the tumor's clinical stage and pathologically free margins in all cases. Further analyses are mandatory to investigate hidden microscopic pathways of tumor diffusion, particularly in bone. Multi-institutional protocols are needed to facilitate comparisons between studies and enable meaningful meta-analyses. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Ameli F.,ENT Unit | Brocchetti F.,ENT Unit | Tosca M.A.,Instituto G Gaslini | Signori A.,University of Genoa | Ciprandi G.,San Martino Hospital
Laryngoscope | Year: 2011

Objectives/Hypothesis: Ear, nose, and throat assessment may be frequently requested for children with allergic rhinitis (AR). Nasal endoscopy allows a thorough evaluation of the nose. The aim of the study was to investigate whether there are endoscopic signs predictive for AR diagnosis in a cohort of children with suspected AR. Study Design: Cohort of observational study. Methods: There were 176 children (99 males; mean age, 7.5 years) studied. Clinical visit, nasal endoscopy, and skin prick test were performed in all patients. Nasal endoscopic signs were pale turbinates, middle turbinate contact, and inferior turbinate contact. The AR diagnosis was made when nasal symptom history was concordant with sensitization. Results: AR was diagnosed in 141 children. Inferior and middle turbinate contact were reliable predictive factors for AR (odds ratio 5.38 and 3.42, respectively), whereas pale turbinates did not predict it. Conclusions: This study suggests that nasal endoscopy may reveal signs predictive for AR diagnosis in children. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

Ciprandi G.,University of Genoa | Tosca M.A.,Instituto G Gaslini | Signori A.,University of Genoa | Ameli F.,ENT Unit
International Journal of Pediatric Otorhinolaryngology | Year: 2010

Objective: Nasal obstruction is a common symptom in childhood. It may be frequently observed in children with allergic rhinitis and/or adenoidal hypertrophy. However, its assessment is very difficult. The aim of the study was to compare the use of both a Face Related Scale (FRS), recorded by children and their parents, and a simplified Visual Analogue Scales (sVAS) with nasal endoscopy in children complaining nasal obstruction. Methods: 121 children (75 males, mean age 7.5 years) were studied. FRS and sVAS for nasal obstruction and endoscopy were performed in all patients. Results: A moderate correlation has been observed between FRS and sVAS and obstruction of nasal anterior segment (r= 0.51 for FRS; r= 0.52 for sVAS), a strong correlation was observed with nasal posterior segment (r= 0.60 for FRS; r= 0.61 for sVAS) assessed by endoscopy. However, parents' perception did not relate with objective parameters. Conclusions: This study suggests that assessment of FRS and sVAS for nasal obstruction may be used in clinical practice to approximately quantify this symptom in children. © 2010 Elsevier Ireland Ltd.

Castelnuovo P.,ENT Unit | Dallan I.,ENT Unit | Locatelli D.,University of Pavia | Battaglia P.,ENT Unit | And 6 more authors.
European Archives of Oto-Rhino-Laryngology | Year: 2012

The objective of the study is to present our multicentric experience on intraorbital lesions managed by means of an endonasal endoscopic approach. The study design used was multi-institutional retrospective review. We collected data on 16 intraorbital medially-located lesions, all managed by means of an endonasal route, treated in four different skull base centers. We retrospectively reviewed the technical details, complications, histology, and general outcome. The endoscopic endonasal approach was effective in removing completely intraorbital extra-intraconal tumors in 8 cases, in performing biopsies for histological diagnosis in 6 intraorbital intraconal tumors, and in draining 1 extraconal abscess. No major complications were observed; in particular, there was no optic nerve damage. Minor, temporary complications (diplopia) were seen in 3 cases; only 2 patients experienced a permanent diplopia related to medial rectus muscle impairment, in 1 case associated with enophthalmos. Our preliminary multi-centric clinical experience suggests that medially located intraorbital lesions, and in particular the infero-medial ones, can be successfully and safely managed by such an approach. The well-known advantages of the endoscopic techniques, namely the lack of external scars, less bleeding, shorter hospital stay, and fewer complications, are confirmed. © Springer-Verlag 2012.

Background: Ear infection is highly prevalent worldwide. In the older child, long-standing Chronic Supparative Ottitis Media can result in a severe conductive hearing loss with significant drawbacks in learning, communication, and social adjustment. It is associated with hearing impairment, death, and severe disability due to central nervous system involvement in developing countries. Objective: To determine the bacteriological profile and antibacterial resistance of ear infection from patients seen at Ear Nose and Throat clinic of Hawassa University Referral Hospital. Materials and Methods: A cross-sectional study was conducted at clinic of Hawassa University Referal Hospital. Result: A total 117 study subjects included in this study from June 2013 to October 2013. Among these, 57 (48.7%) were male and 53 (45.3%) were children. Bacteria identified from positive ear swabs were: Staphylococcus aureus 24 (20.5%), Pseudomonas aeroginosa 17 (14.5%), Klebsiella species 10 (8.5%), Proteus species 7 (6.0%), Entrobacter species 4 (3.4%), Escherchia coli 3 (2.6%), Citrobacter species 2 (1.7%), and Providentia species 2 (1.7%). The overall sensitivity and resistance profile of antibacterial agent, Amikacin (90.0%) and Gentamycin (89.1) showed high level of antibacterial effect on all identified bacterial species. On other hand, all isolates were highly resistance to ampicilin (87.5%), oxacillin (84.0%), ceftriaxone (82.8%), cephalotin (81.4%), and penicillin G (73.8%). Conclusion: Most of the isolates were resistant to commonly prescribed drug in the area. However, Amikacin and Gentamycin were highly active against the isolated organism, whereas Ciprofloxacilin was moderately active. Therefore, culture and susceptibility test is vital for appropriate management of ear infection in study area. © 2014 Indian Journal of Otology.

Capasso M.,Ospedale Civile Ave Gratia Plena | Varricchio A.,ENT Unit | Ciprandi G.,University of Genoa
Allergy: European Journal of Allergy and Clinical Immunology | Year: 2010

Background: Relevant relationship exists between upper and lower airways. Bronchial obstruction is a paramount feature of asthma and its reversibility is considered a diagnostic step for asthma diagnosis. Objective: This study aimed at evaluating a large group of children with allergic rhinitis alone for investigating the degree of brochodilation and possible factors related to it. Methods: Two hundred patients with allergic rhinitis and 150 normal subjects were consecutively evaluated. Clinical examination, skin prick test, spirometry, and bronchodilation test were performed in all patients. Results: Rhinitics showed a significant FEV1 increase after bronchodilation test (P < 0.0001) in comparison both to basal values and to controls' levels. More than 20% of rhinitics had reversibility (≥12% basal levels). Patients with reversibility had lower FEV1 levels, longer rhinitis duration, and perennial allergy. Conclusion: This study highlights the close link between upper and lower airways and the relevance of performing bronchodilation test in patients with allergic rhinitis and these characteristics. © 2009 John Wiley & Sons A/S.

Vicini C.,Gb Morgagni L Pierantoni Hospital | Montevecchi F.,Gb Morgagni L Pierantoni Hospital | Pang K.,Pacific Sleep Center | Bahgat A.,Alexandria University | And 3 more authors.
Head and Neck | Year: 2014

Background Transoral robotic surgery (TORS) for obstructive sleep apnea-hypopnea syndrome is a relatively young technique principally devised for managing apneas in the tongue base (TB) area and supraglottic larynx. This procedure is included in the so-called "multilevel surgery" often including a palatal and nasal surgery. Methods We carried out a retrospective analysis in order to understand in detail the relative impact on apneas of the 2 different procedures carried out in the palate area (expansion sphincter pharyngoplasty and uvulopalatopharyngoplasty). We evaluated 2 groups, each of 12 cases, which were sorted according to the primary selection criteria of statistically comparable preoperative apnea-hypopnea index (AHI), sex, age, body mass index (BMI), and volume of removed TB tissue. Results Postoperative AHI registered was of 9.9 ± 8.6 SD for the expansion sphincter pharyngoplasty group and 19.8 ± 14.1 SD for the uvulopalatopharyngoplasty group. Conclusion As the palate component of our multilevel procedure, expansion sphincter pharyngoplasty, including conventional nose surgery and robotic surgery, seems to be superior to uvulopalatopharyngoplasty. © 2013 Wiley Periodicals, Inc.

Scotti C.,University of Pavia | Olivieri C.,University of Pavia | Boeri L.,University of Pavia | Canzonieri C.,University of Pavia | And 4 more authors.
PLoS ONE | Year: 2011

Activin A receptor, type II-like kinase 1 (also called ALK1), is a serine-threonine kinase predominantly expressed on endothelial cells surface. Mutations in its ACVRL1 encoding gene (12q11-14) cause type 2 Hereditary Haemorrhagic Telangiectasia (HHT2), an autosomal dominant multisystem vascular dysplasia. The study of the structural effects of mutations is crucial to understand their pathogenic mechanism. However, while an X-ray structure of ALK1 intracellular domain has recently become available (PDB ID: 3MY0), structure determination of ALK1 ectodomain (ALK1 EC) has been elusive so far. We here describe the building of a homology model for ALK1 EC, followed by an extensive bioinformatic analysis, based on a set of 38 methods, of the effect of missense mutations at the sequence and structural level. ALK1 EC potential interaction mode with its ligand BMP9 was then predicted combining modelling and docking data. The calculated model of the ALK1 EC allowed mapping and a preliminary characterization of HHT2 associated mutations. Major structural changes and loss of stability of the protein were predicted for several mutations, while others were found to interfere mainly with binding to BMP9 or other interactors, like Endoglin (CD105), whose encoding ENG gene (9q34) mutations are known to cause type 1 HHT. This study gives a preliminary insight into the potential structure of ALK1 EC and into the structural effects of HHT2 associated mutations, which can be useful to predict the potential effect of each single mutation, to devise new biological experiments and to interpret the biological significance of new mutations, private mutations, or non-synonymous polymorphisms. © 2011 Scotti et al.

Sudden sensorineural hearing loss is a true audiological emergency, and its management is much discussed. Currently, no single therapy has been proven effective according to evidence criteria. Recently, intratympanic application of steroids has been increasingly used in refractory cases; however, it has only rarely been reported as first-line therapy. Twenty consecutive patients with sudden sensorineural hearing loss treated between July 2008 and January 2010 were enrolled in this prospective, case-control study. Ten patients were treated with intratympanic steroids and 10 with systemic 'shotgun' therapy (including steroids, pentoxifylline, low molecular weight heparin and vitamin E). The two groups were homogeneous in all respects. Pure tone averages were assessed before and after treatment for both groups. There were no statistically significant differences between the two groups. Intratympanic steroids seem to offer a valid alternative to systemic therapy, with few risks, in sudden sensorineural hearing loss patients, and we recommend their use as first-line therapy.

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