Design of a study to investigate the mechanisms of obstructive sleep apnoea by means of drug-induced sleep endoscopy

Background Obstructive sleep apnoea (OSA) is an independent risk factor of hypertension and cardiovascular diseases. Recurrent episodes of upper airways collapse during sleep causing blood oxygen desaturation, hypercapnia, and micro-arousals, are known to activate the sympathetic nervous system (SNS). However, whether changes in the renin-angiotensin-aldosterone system and endothelial activation also occur remains contentious. Methods Based on routine use of drug-induced sleep endoscopy (DISE) for the work-up of OSA patients in our centre, we designed a prospective study to investigate the haemodynamic and humoral changes occurring during the apnoeic episodes reproduced in vivo in the course of DISE. Specifically, plasma aldosterone concentration and renin activity, C-terminal fragment of proendothelin-1, as a marker of endothelial damage, and free plasma catecholamines, will be measured at fixed times during DISE. The activity of catechol-O-methyltransferase (COMT), a key catecholamine-inactivating enzyme that has been scantly investigated thus far owing to the lack of commercially available kits, will be also determined by a newly developed high performance liquid chromatography method, which is herein described. Results and conclusions The aim of this study is to provide novel information on the haemodynamic, hormonal, and SNS changes, and also on COMT activity modification concomitantly occurring during apnoea, thus contributing substantively to the understanding of the pathophysiology of OSA

Advanced lung cancer inflammation index and its prognostic value in HPV-negative head and neck squamous cell carcinoma: a multicentre study

Purpose: The aim of this study is to evaluate the prognostic value of pre-treatment advanced lung cancer inflammation index (ALI) in patients with HPV-negative HNSCC undergoing up-front surgical treatment. Methods: The present multi-centre, retrospective study was performed in a consecutive cohort of patients who underwent upfront surgery with or without adjuvant (chemo)-radiotherapy for head and neck squamous cell carcinoma (HNSCC). Patients were stratified by ALI, and survival outcomes were compared between groups. In addition, the prognostic value of ALI was compared with two other indices, the prognostic nutritional index (PNI) and systemic inflammatory index (SIM). Results: Two hundred twenty-three patients met the inclusion criteria (151 male and 72 female). Overall and progression-free survival were significantly predicted by ALI < 20.4 (HR 3.23, CI 1.51–6.90 for PFS and HR 3.41, CI 1.47–7.91 for OS). Similarly, PNI < 40.5 (HR = 2.43, 95% CI: 1.31–4.51 for PFS and HR = 2.40, 95% CI: 1.19–4.82 for OS) and SIM > 2.5 (HR = 2.51, 95% CI: 1.23–5.10 for PFS and HR = 2.60, 95% CI: 1.19–5.67 for OS) were found to be significant predictors. Among the three indices, ALI < 20.4 identified the patients with the worst 5-year outcomes. Moreover, patients with a combination of low PNI and low ALI resulted to be a better predictor of progression (HR = 5.26, 95% CI: 2.01–13.73) and death (HR = 5.68, 95% CI: 1.92–16.79) than low ALI and low PNI considered alone. Conclusions: Our results support the use of pre-treatment ALI, an easily measurable inflammatory/nutritional index, in daily clinical practice to improve prognostic stratification in surgically treated HPV-negative HNSCC

Olfactory Dysfunction in COVID-19 Patients Who Do Not Report Olfactory Symptoms: A Pilot Study with Some Suggestions for Dentists

Background: Smell and taste dysfunction are frequently reported by SARS-CoV-2 positive patients. The degree of olfactory and gustatory dysfunction varies from a very mild reduction to their complete loss. Several studies have been performed to determine their prevalence in COVID-19 patients, mostly using subjective measurement methods. The literature lacks long-term studies regarding duration and recovery. Methods: We assessed olfactory performance, using the Sniffin’ Sticks olfactory test, in a group of patients who had not reported olfactory dysfunction, around 131 days after their COVID-19 diagnosis. Results: 11 out of 20 subjects showed no olfactory reduction (65%), while 9 subjects showed reduced TDI score (45%). A total of 13 subjects (65%) scored above the cutoff point for Threshold, 16 subjects (80%) scored above the cutoff point for discrimination and 13 subjects (65%) scored above the cutoff point for identification. Conclusion: Objective measurement methods of olfactory performance show a higher prevalence of olfactory reduction compared to patients’ self-reported questionnaires. Olfactory dysfunction can last even months after its onset and because of its high prevalence, it could be a screening symptom for suspect COVID-19 case

Trattamento dei carcinomi laringei con deficit di motilità aritenoidea: risultati preliminari dello studio ARYFIX

Trattamento dei carcinomi laringei con deficit di motilità aritenoidea: risultati preliminari dello studio ARYFIXFrancesca Mularoni (1) - Erika Crosetti (2) - Alperen Vural (3) - Piergiorgio Gaudioso (1) - Matteo Fermi (4) -Stefano Taboni (1) - Andrea Luigi Camillo Carobbio (1) - Nausica Montalto (1) - Francesco Rigoni (1) - TommasoSaccardo (1) - Alessandra Ruaro (1) - Chiara Varago (1) - Maria Baldovin (1) - Luigia Bandolin (1) - Alfredo LoManto (5) - Filippo Marchi (6) - Marta Filauro (6) - Francesco Missale (6) - Alessandro Ioppi (6) - Filippo Carta (7) -Cinzia Mariani (7) - Valeria Marrosu (7) - Melania Tatti (7) - Sedat Cağlı (3) - Imdat Yüce (3) - Mete Gündoğ (8) -Serap Dogan (9) - Francesca Del Bon (10) - Alberto Paderno (10) - Davide Lancini (10) - Giuseppe Anile (11) -Chiara Gottardi (12) - Fabio Busato (13) - Alberto Vallin (6) - Simone Caprioli (14) - Francesca Gennarini (10) -Gino Marioni (1) - Cesare Piazza (10) - Paolo Bossi (15) - Francesco Mattioli (5) - Roberto Puxeddu (7) - MariaGrazia Ghi (11) - Livio Presutti (4) - Marco Lionello (16) - Andy Bertolin (16) - Giovanni Succo (2) - Giorgio Peretti(6) - Piero Nicolai (1) - Marco Ferrari (1)Università degli studi di Padova, Dipartimento di Neuroscienze, Otorinolaringoiatria, Padova, Italia (1) -IRCCS Istituto di Candiolo, Dipartimento di Otorinolaringoiatria, Torino, Italia (2) - Erciyes University,Department of Otorhinolaryngology, Kayseri, Turchia (3) - Università degli studi di Bologna, Dipartimento diOtorinolaringoiatria, Bologna, Italia (4) - Università degli studi di Modena, Dipartimento di Otorinolaringoiatria,Modena, Italia (5) - IRCCS Ospedale Policlinico San Martino, Dipartimento di Otorinolaringoiatria, Genova,Italia (6) - Azienda Ospedaliero-Universitaria di Cagliari, Dipartimento di Otorinolaringoiatria, Cagliari, Italia (7)- Erciyes University, Department of Radiation Oncology, Kayseri, Turchia (8) - Erciyes University, Departmentof Radiology, Kayseri, Turchia (9) - Università degli studi di Brescia, Dipartimento di Otorinolaringoiatria,Brescia, Italia (10) - Istituto oncologico Veneto IRCCS, Oncologia 2, Padova, Italia (11) - Università degli studidi Padova/ Istituto oncologico Veneto IRCCS, Oncologia 2, Padova, Italia (12) - Istituto oncologico VenetoIRCCS, Dipartimento di Radioterapia, Padova, Italia (13) - IRCCS Ospedale Policlinico San Martino,Dipartimento di Radiologia, Genova, Italia (14) - Università degli studi di Brescia, Dipartimento di Oncologia,Brescia, Italia (15) - Ospedale di Vittorio Veneto, Dipartimento di Otorinolaringoiatria, Treviso, Italia (16)Razionale: Il deficit della motilità aritenoidea è un elemento rilevante nei pazienti affetti da carcinomalaringeo. Può essere classificato come ipomotilità o fissità ed è attribuibile a vari meccanismi legatiall’estensione della neoplasia verso la porzione posteriore dello spazio paraglottico inferiore. Tale estensionecomporta un peggioramento della prognosi nei pazienti sottoposti a chirurgia parziale (OPHL), mentre alcunistudi sembrano indicare che la prognosi dei pazienti trattati con laringectomia totale non risulta influenzatadallo stesso pattern di crescita. Lo scopo dello studio è identificare il miglior trattamento nei pazienti affetti dacarcinoma laringeo con compromissione della motilità aritenoidea.Materiali e metodi: È stato condotto uno studio retrospettivo multicentrico, includendo pazienti affetti dacarcinoma laringeo con compromissione della motilità aritenoidea. In questa analisi preliminare sono stativalutati l’overall survival (OS) e la severe laryngoesophageal dysfunction-free survival (SLEDFS). I dati sonostati analizzati mediante un’analisi univariata con il metodo di Kaplan-Meier e il log-rank test.Risultati: Lo studio ha incluso 391 pazienti, con età media di 64 anni. 25 (6,4%) tumori sono stati classificaticome T2, 225 (57,5%) come T3 e 139 (35,5%) come T4. Sulla base della valutazione endoscopicapreoperatoria 209 pazienti si presentavano con ipomotilità aritenoidea e 182 con fissità. I trattamentieffettuati hanno compreso: laringectomia totale (n=179, 45,8%), OPHL di tipo II (n=110, 28,1%), OPHL ditipo III (n=32, 8,2%) o (chemio)radioterapia preceduta o meno da chemioterapia neoadiuvante (n=70,17,9%). Il trattamento adiuvante è stato eseguito in 141 casi (44,2%). L’OS a 5 anni è risultata del 71,8%. Ilgrado di ipomotilità aritenoidea è risultato significativamente associato all’OS a 5 anni (fissità aritenoidea61,6%, ipomotilità 79,2%; p=0,007). Nei pazienti trattati con preservazione d’organo l’OS a 5 anni è risultatadell’81,0%, rispetto al 57,7% dopo laringectomia totale (p=0,0004).Nei pazienti con preservazione d’organo la SLEDFS a 5 anni è risultata dell’85,4%. L’OPHL di tipo II èrisultata associata a SLEDFS a 5 anni superiore (91,6%) rispetto a OPHL di tipo III (73,9%) e trattamenti nonchirurgici (79,9%) (p=0,042). La radioterapia esclusiva è risultata associata ad una riduzione della OS(p&lt;0,0001) e della SLEDFS (p=0,071).Conclusioni: Il deficit di motilità aritenoidea ha dimostrato un ruolo prognostico negativo nei pazienti affettida carcinoma laringeo. I trattamenti di preservazione d’organo non hanno comportato un peggioramentodella prognosi rispetto alla laringectomia totale. La funzione laringea post-trattamento è risultatasoddisfacente, specialmente nei pazienti sottoposti a OPHL di tipo II. I pazienti trattati con radioterapiaesclusiva hanno presentato risultati oncologici e funzionali peggiori rispetto alle altre strategie dipreservazione d’organo.</p

HCV infection and the risk of head and neck cancer: A meta-analysis

Recent evidence has consistently suggested a role for HCV in the etiology of head and neck squamous cell carcinoma (HNSCC), but the conclusions of these studies have often been limited by small sample size. Therefore, a meta-analysis was performed to summarize present evidence on the association between HCV infection and HNSCC. After screening citations from literature search, eight observational studies investigating the association between HCV and cancer(s) of either oral cavity, oropharynx, hypopharynx or larynx were included. For each cancer site, risk ratios from individual studies were displayed in forest plots; pooled risk ratios (RR) and corresponding confidence intervals (CI) were calculated. A significant association was found between HCV infection and cancers of the oral cavity (RR = 2.13; 95%: 1.61-2.83), oropharynx (RR = 1.81; 95% CI: 1.21-2.72), and larynx (RR = 2.57; 95% CI: 1.11-5.94). A similar picture emerged for hypopharyngeal cancer, though this result did not fully reach statistical significance because of the small number of available studies (RR = 2.15; 95% CI: 0.73-6.31). These findings remained similar after exclusion of patients with HIV co-infection. Our results highlighted the importance of surveillance of the upper aerodigestive tract in patients with known chronic HCV infections in order to enable HNSCC early diagnosis. In addition, they could be a reminder of the possibility of undiagnosed HCV infection to the clinicians treating HNSCC

HCV infection and the risk of head and neck cancer: A meta-analysis

Recent evidence has consistently suggested a role for HCV in the etiology of head and neck squamous cell carcinoma (HNSCC), but the conclusions of these studies have often been limited by small sample size. Therefore, a meta-analysis was performed to summarize present evidence on the association between HCV infection and HNSCC. After screening citations from literature search, eight observational studies investigating the association between HCV and cancer(s) of either oral cavity, oropharynx, hypopharynx or larynx were included. For each cancer site, risk ratios from individual studies were displayed in forest plots; pooled risk ratios (RR) and corresponding confidence intervals (CI) were calculated. A significant association was found between HCV infection and cancers of the oral cavity (RR\ua0=\ua02.13; 95%: 1.61-2.83), oropharynx (RR\ua0=\ua01.81; 95% CI: 1.21-2.72), and larynx (RR\ua0=\ua02.57; 95% CI: 1.11-5.94). A similar picture emerged for hypopharyngeal cancer, though this result did not fully reach statistical significance because of the small number of available studies (RR\ua0=\ua02.15; 95% CI: 0.73-6.31). These findings remained similar after exclusion of patients with HIV co-infection. Our results highlighted the importance of surveillance of the upper aerodigestive tract in patients with known chronic HCV infections in order to enable HNSCC early diagnosis. In addition, they could be a reminder of the possibility of undiagnosed HCV infection to the clinicians treating HNSCC

Correct Execution of the Nasopharyngeal Swab: A Fundamental Method to Improve Diagnosis of SARS-CoV-2 Infection

Background: Severe acute respiratory infection Coronavirus 2 (SARS-CoV-2) infection has spread all over the world since December 2019. Treatment of the syndrome represents an important challenge for all physicians. Spread prevention relies on a correct diagnosis which is performed with nasopharyngeal swabs. Objective: To describe the proper execution of the swab with a few simple steps. Methods: Figures and video recording. Results: A few simple steps are presented within this paper in order to perform easily nasopharyngeal swab for SARS-Cov-2 diagnosis and for other possible infectious diseases of the airways tract. Conclusions and implication for nursing: Nasopharyngeal swab may be performed in an easier way than usually thought. This method may also be used for any other microorganism detection. By following simple steps, a correct diagnosis can easily be obtained

COVID-Q: validation of the first COVID-19 questionnaire based on patient-rated symptom gravity

none10The aim of the present study was to develop and validate the CoronaVirus-Disease-2019 (COVID-19) Questionnaire (COVID-Q), a novel symptom questionnaire specific for COVID-19 patients, to provide a comprehensive evaluation which may be helpful for physicians, and evaluate questionnaire's performance in identifying subjects at higher risk of testing positive.noneSpinato, Giacomo; Fabbris, Cristoforo; Conte, Federica; Menegaldo, Anna; Franz, Leonardo; Gaudioso, Piergiorgio; Cinetto, Francesco; Agostini, Carlo; Costantini, Giulio; Boscolo-Rizzo, PaoloSpinato, Giacomo; Fabbris, Cristoforo; Conte, Federica; Menegaldo, Anna; Franz, Leonardo; Gaudioso, Piergiorgio; Cinetto, Francesco; Agostini, Carlo; Costantini, Giulio; Boscolo-Rizzo, Paol

Risk management during COVID-19: safety procedures for otolaryngologists

The pandemic caused by SARS-CoV2 has stressed health care systems worldwide. The high volume of patients, combined with an increased need for intensive care and potential transmission, has forced reorganization of hospitals and care delivery models. In this article, are presented approaches to minimize risk to Otolaryngologists during their patients infected with COVID-19 care. We performed a narrative literature review among PubMed, Scopus and Web of Science electronic databases, searching for studies on SARS-CoV2 and Risk Management. Standard operating procedures have been adapted both for facilities and for health care workers, including the development of well-defined and segregated patient care areas for treating those affected by COVID-19. Personal protective equipment (PPEs) availability and adequate healthcare providers training on their use should be ensured. Preventive measures are especially important in Otolaryngology-Head and Neck Surgery, as the exposure to saliva suspensions, droplets and aerosols are increased in the upper aero-digestive tract routine examination. Morever, the frequent invasive procedures, such as laryngoscopy, intubation or tracheotomy placement and care, represent a high risk of contracting COVID-19

Olfactory and taste dysfunction among mild-to-moderate symptomatic COVID-19 positive health care workers: An international survey

OBJECTIVE: To determine the prevalence of olfactory and taste dysfunction (OD; TD) among COVID‐19 positive health care workers (HCWs), their associated risk factors and prognosis. METHODS: Between May and June 2020, a longitudinal multicenter study was conducted on symptomatic COVID‐19 PCR confirmed HCWs (COVID‐19 positive) in London and Padua. RESULTS: Hundred and fourteen COVID‐19 positive HCWs were surveyed with a response rate of 70.6% over a median follow‐up period of 52 days. UK prevalence of OD and TD was 73.1% and 69.2%, respectively. There was a male to female ratio of 1:3 with 81.6% being white, 43.7% being nurses/health care assistants (HCAs), and 39.3% being doctors. In addition, 53.2% of them worked on COVID‐19 wards. Complete recovery was reported in 31.8% for OD and 47.1% for TD with a 52 days follow‐up. The job role of doctors and nurses negatively influenced smell (P = .04 and P = .02) and taste recovery (P = .02 and P = .01). Ethnicity (being white) showed to positively influence only taste recovery (P = .04). Sex (being female) negatively influenced OD and TD recovery only in Paduan HCWs (P = .02 and P = .011, respectively). Working on a COVID‐19 ward did not influence prognosis. CONCLUSIONS: The prevalence of OD and TD was considerably higher in HCWs. The prognosis for OD and TD recovery was worse for nurses/HCAs and doctors but working on a COVID‐19 ward did not influence prognosis. Sixty‐eight percent of surveyed HCWs at 52 days continued to experience OD or TD requiring additional future medical management capacity. LEVEL OF EVIDENCE: 4