Vertigini nell'infanzia. Analisi della letteratura e casistica personale.

Vertigine, dal latino vertere, girare, è il termine utilizzato per indicare la vera e propria vertigine rotatoria. Dizziness, è invece il termine utilizzato nei paesi anglosassoni, per indicare una serie di sensazioni, quali sensazioni di instabilità, pulsioni laterali, sensazione di camminare su una superficie soffice, sensazione di impellente svenimento, testa pesante o leggera. Una percezione erronea del movimento può essere dovuta, nei bambini come negli adulti, ad un’anomalia nella normale funzione dei tre sistemi sensoriali principali: il sistema visivo, il sistema vestibolare e il sistema somatosensoriale. Sebbene nei bambini lo spettro delle patologie che causano dizziness sia uguale a quello degli adulti, la frequenza delle diverse patologie è differente. Vertigine e dizziness, specialmente nell’infanzia, sono spesso causa di un eccessivo numero di prescrizioni per test inutili e costosi a causa dell’ansia generata dalla mancanza di conoscenza e della mancanza di un algoritmo diagnostico chiaro. Questo studio analizza, sulla base dell’esperianza clinica e dei dati della letteratura, tutte le caratteristiche anamnesiche rilevanti, al fine di proporre un algoritmo diagnostico che guidi il sospetto clinico del medico verso una corretta formulazione della diagnosi nel bambino vertiginoso senza chiari segni di coinvolgimento neurologico. Lo studio si basa sull’analisi retrospettiva dei reperti clinici e strumentali di 37 bambini sottoposti a completa valutazione otoneurologica per riferita sintomatologia vertiginosa. Tutte le diagnosi sono state confermate applicando i più recenti criteri diagnostici internazionali. Nella nostra casistica la più comune causa di vertigine in età pediatrica è risultata quella di origine emicranica (38%), seguita dalla nevrite vestibolare (16%) e dalla vertigine psicogena (16%). La vertigine parossistica benigna dell’infanzia è stata diagnosticata in 4 pazienti (11%), mentre il torcicollo parossistico in un solo bambino di un anno. In un 8% (3 pazienti) la vertigine aveva un’origine post-traumatica. La Malattia di Menière è stata diagnosticata in 2 casi (5%). Una vestibolopatia bilaterale di origine sconosciuta è stata riscontrata come causa di una dizziness cronica in uno dei pazienti. L’algoritmo ha pochi semplici step, basati principalmente su due aspetti fondamentali: andamento temporale della vertigine e presenza di sintomi uditivi durante la vertigine. Considerazioni separate devono essere fatte per i casi nei quali è supposta un'origine traumatica; per questa ragione è stato proposto un diverso algoritmo che conduce a differenti diagnosi (come vertigine parossistica posizionale benigna o concussione cocleo-labirintica)

Medical-surgical management and clinical outcome in cervical abscesses.

Introduction: This study aims at defining through a retrospective evaluation, the clinical parameters affecting the clinical course and consequently the management of patients presenting with cervicofacial abscesses. Methodology: A total of 394 patients diagnosed with abscess at the University of Sassari Otorhinolaryngology Division between 2009 and 2017 were included; among these, eleven patients were diagnosed with necrotizing fasciitis. Personal and clinical parameters including the LRINEC score and the medical and/or surgical treatment used were analyzed for each patient. The most frequently affected site was the peritonsillar space (76.9%), followed by the parapharyngeal space. Results: Mean age was 41(±17) years, the male population was slightly overrepresented (68%). An average of 6 (±7) days of hospitalization duration was recorded. The mortality rate was confirmed to be relatively low (1/349 patients) and was reported only in one patient diagnosed with necrotizing fasciitis (1/11). Conclusion: Diagnosis, correct clinical definition and early medical-surgical treatment of neck abscesses were crucial to reduce complications; LRNEC score, C-reactive protein, glycemia and creatininemia proved to be reliable prognostic indicators of difficult patient management and risk of complications

Wait and Scan Management of Intra-canalicular Vestibular Schwannomas: Analysis of Growth and Hearing Outcome

Objective: To report on the results of intracanalicular vestibular schwannomas (ICVS) that were managed by wait and scan and to analyze the possible predictors of tumor growth and hearing deterioration throughout the observation period. Study design: A retrospective case series. Setting: Quaternary referral center for skull base pathologies. Patients: Patients with sporadic ICVS managed by wait and scan. Intervention: Serial resonance imaging (MRI) with size measurement and serial audiological evaluation. Main outcome measure: Tumor growth defined as 2 mm increase of maximal tumor diameter, further treatment, and hearing preservation either maintain initial modified Sanna hearing class, or maintain initial serviceable hearing (class A/B). Results: 339 patients were enrolled. The mean follow-up was 36.5±31.7 months with a median of 24 months. Tumor growth occurred in 141 patients (40.6%) either as slow growth (SG) in 26.3% of cases or fast growth (FG) in 15.3% of cases. Intervention was performed in only 64 cases (18.8%). Out of 271 patients who underwent hearing analysis, 86 patients (33.5%) showed hearing deterioration to a lower hearing class of the modified Sanna classification. Tumor growth and older age were predictors of hearing deterioration. Of the 125 cases with initial serviceable hearing (Class A/B), 91 cases (72.8%) maintained serviceable hearing at last follow-up. Tumor growth and a worse initial pure tone average (PTA) were predictors of hearing deterioration. Conclusions: Wait and scan management of ICVS is a viable option and only 18.8% of patients needed further treatment. Hearing tends to deteriorate over time

HDR interventional radiotherapy (brachytherapy) in the treatment of primary and recurrent head and neck malignancies

BACKGROUND: Interventional radiotherapy (brachytherapy; IRT) reemerged in the last decades as a potentially useful tool in head and neck oncology after a set of clear technical improvements were developed. METHODS: Sixty-one high dose ratio (HDR) IRT treatments were recommended and performed on 58 patients. We classified the cases into four relatively homogeneous groups based on the clinical needs that led to the recommended IRT. Also, we separately evaluated primary and recurrent cases. RESULTS: Disease-specific survival was significantly different among the four treatment groups. The group with the best prognosis was the cohort treated locally by exclusive interstitial IRT for resectable midface malignancies (2-year relapse-free survival = 82%, disease-specific survival = 89%). CONCLUSION: HDR IRT is a valuable tool in well-defined clinical situations and, in particular, in recurrences. In midface malignancies, it could become the preferred primary treatment