F.E.S.S. Complications

Nasal Endoscopic Surgery still supports endonasal surgery expansion and this expansion can cause a real increase in complications due very often to superficial knowledge of endoscopic and radiologic anatomy, surgical inexperience and inadequate surgical instruments. The surgeons’ practical experience in the progressive use of the endoscope is fundamental such as practical training in surgical therapeutic procedures on the cadaver. Be reminded that the learning curve can have a decrease in the year when surgeons think being sufficiently expert and going through surgery without adequate thinking. Nose and paranasal sinuses anatomic complexity can be involved in sequaelae arising such as previous surgery, nature and extension of the illness. From a didactic point of view, we classify the complications of ESS as: intranasal complications; periorbital/orbital complications; intracranial complications; Systemic complications; other complications (bronchospamus, asthmatic crisis, cephalalgia, otalgia, atrophic rhinitis, dry rhinitis, anosmia, mucoceles). Even if we believe that endoscopic rhinosinus surgery is a safe technique and the results are superior in relation to conventional techniques, and the rate of complications inferior, successful results in endoscopic rhinosinus surgery require good knowledge of endosopic anatomy, good knowledge of TC scan anatomy and an adequate training in surgical procedures

Benign Paroxysmal Positional Vertigo (BPPV) in COVID-19

Objective: The purpose of this article is to describe BPPV in COVID-19 patients by discussing the possible mechanisms underlying the onset of this vertigo. Methods: We studied eight patients (4 F, 4 M, aged between 44 and 69 years) with COVID-19 infections complaining of vertigo. Patients were evaluated at the end of infection with an accurate clinical history, and the investigation of spontaneous, positional and positioning nystagmus. Results: The vestibular findings showed benign paroxysmal positional vertigo (BPPV) in all the patients. Three patients had a mild phenotype of the COVID infection, whereas five subjects were hospitalized for the COVID infection and in three cases intensive care was required. Vestibular evaluation showed an involvement of posterior semicircular canals in five patients and horizontal in three. Three patients were treated with the Epley maneuver, two with Semont, one with Lempert and two with Gufoni maneuvers. Conclusions: We hypothesize that BPPV in COVID-19 infections can be relate to drugs, prolonged bed rest and to direct damage by viral infection on the peripheral vestibular system and in particular on the otolitic membrane due to the cytopathic effect of the virus and to the inflammatory response. Studies on large series of patients are needed to confirm our preliminary observation and to better evaluate the pathophysiological mechanisms underlying BPPV in these patients

Functional results of exclusive interventional radiotherapy (brachytherapy) in the treatment of nasal vestibule carcinomas.

Surgery, external beam radiotherapy (EBRT), and interventional radiotherapy (IRT, BrachyTherapy BT) are the current therapeutic options for nose vestibule (NV) squamous cell carcinoma (SCC). In this article, we evaluate the nose functional parameters of patients affected by SCCs of the NV, primarily treated by interstitial IRT comparing them with healthy controls and with patients treated with intensity-modulated EBRT.Ten patients treated by using IRT (group 1), 10 healthy controls and eight patients treated by EBRT (group 2) on the region of the nose were submitted to clinical evaluation (with the NOSE scale score), rhinomanometry, olfactory testing, nasal citology, and evaluation of mucociliary clearance through saccharine test.No long-term skin or cartilaginous toxicity are recorded. The olfactometry threshold discrimination identification TDI is lower in EB group. The mean NOSE scale score was significantly higher in group 2 than in group 1 and healthy controls (p0.05). The distribution of cytologic patterns resulted significantly different as well. Patients treated by EB have a significantly impaired mucociliary clearance, with a mean time for the transport of the stained marker, which is more than double in the patients treated by EB than in those treated with IRT (p0.001).Nasal function and cytological findings are significantly better, substantially preserved, in patients treated by IRT than in those treated by EBRT, bringing new relevant evidence for the establishment of interstitial IRT as the new standard for the treatment of the primary lesion in cT1 and cT2 -Wang staging NV SCCs

Hereditary Haemorrhagic Telangiectasia: a disease not to be forgotten during the COVID-19 pandemic

From November 2019 to date, almost six thousand papers have been published on COVID-19, the disease caused by SARS-CoV-2 infection. As physicians working in a multidisciplinary centre for the cure of Hereditary Haemorrhagic Telangiectasia (HHT) in a country (Italy) that has been severely affected by COVID-19, we are surprised that, among this impressive amount of publications, there is none on HHT. Indeed, we performed our last PubMed search on 22 April 2020, using the keywords "Hereditary Haemorrhagic Telangiectasia" OR "Hereditary Hemorrhagic Telangiectasia" OR "HHT" OR "Rendu-Osler-Weber" AND "COVID-19" OR "coronavirus", and found no papers. This is surprising, because, although HHT is a rare disease, there are many reasons why we believe that it deserves special attention during the COVID-19 pandemic

Long-term voice outcomes and quality of life after open partial horizontal laryngectomy type II vs. total laryngectomy: A cross-sectional study

Objectives: We aim to analyse long-term voice outcomes and quality of life (QoL) in patients undergoing open partial horizontal laryngectomy type II (OPHL type II) and to compare them to those obtained by patients undergoing total laryngectomy (TL) with voice prosthesis (VP). Design: Cross-sectional cohort study. Setting: Patients undergoing surgery for advanced laryngeal cancer, assessed during the usual follow-up consultations at the Phoniatric Unit (February 2020-December 2020). Participants: Forty-five patients were enrolled and divided into two groups: OPHL group and TL group. Main outcomes measures: Acoustic analysis, maximum phonation time, INFV0 scale, I-SECEL, UW-QoL-V4 and MDADI questionnaires were used to assess the long-term outcomes. Results: Voices of patients undergoing OPHL Type II were worse than those of laryngectomised patients with VP. Nevertheless, scores in voice and dysphagia-related QoL were comparable and scores in the social domain of QoL were higher in OPHL group. Conclusions: Open partial horizontal laryngectomy Type II allows an acceptable voice recovery and

Decision Making on Vestibular Schwannoma: Lessons from a Multidisciplinary Board

BACKGROUND: Management of vestibular schwannoma (VS) is a complex process aimed at identifying a clinical indication for fractionated stereotactic radiotherapy (sRT) or radiosurgery, microsurgical resection, or wait and scan (WS). We describe the experience of our VS multidisciplinary team (MDT) at a tertiary university referral center created for diagnosis, treatment, and follow-up of VS patients. METHODS: We conducted a retrospective study on 132 consecutive patients referred to the MDT and managed by observation (WS), microsurgery, or fractionated sRT. The analysis included patient age, tumor size, hearing level, facial nerve function, tumor control, complications, and quality of life questionnaires. RESULTS: Among the patients, 21% were subjected to microsurgery, 10% to sRT, and 69% to WS. The median follow-up time was 30 months. Outcomes based on different management modalities are described. Statistically significant differences among groups were detected in terms of quality of life (physical domain). CONCLUSIONS: MDT may provide the best individualized therapy for VS patients compared with a single gold standard strategy

Malnutrition in COVID-19 survivors: prevalence and risk factors

Background: Nutritional status is a critical factor throughout COVID-19 disease course. Malnutrition is associated with poor outcomes in hospitalized COVID-19 patients. Aim: To assess the prevalence of malnutrition and identify its associated factors in COVID-19 survivors. Methods: Study cohort included 1230 COVID-19 survivors aged 18-86 attending a post-COVID-19 outpatient service. Data on clinical parameters, anthropometry, acute COVID-19 symptoms, lifestyle habits were collected through a comprehensive medical assessment. Malnutrition was assessed according to Global Leadership Initiative on Malnutrition (GLIM) criteria. Results: Prevalence of malnutrition was 22% at 4-5 months after acute disease. Participants who were not hospitalized during acute COVID-19 showed a higher frequency of malnutrition compared to those who needed hospitalization (26% versus 19%, p < 0.01). Malnutrition was found in 25% COVID-19 survivors over 65 years of age compared to 21% younger participants (p < 0.01). After multivariable adjustment, the likelihood of being malnourished increased progressively and independently with advancing age (Odds ratio [OR] 1.02; 95% CI 1.01-1.03) and in male participants (OR 5.56; 95% CI 3.53-8.74). Malnutrition was associated with loss of appetite (OR 2.50; 95% CI 1.73-3.62), and dysgeusia (OR 4.05; 95% CI 2.30-7.21) during acute COVID-19. Discussion: In the present investigation we showed that malnutrition was highly prevalent in a large cohort of COVID-19 survivors at 4-5 months from acute illness. Conclusions: Our findings highlight the need to implement comprehensive nutritional assessment and therapy as an integral part of care for COVID-19 patients

COVID-19 atypical Parsonage-Turner syndrome: a case report

Background Neurological manifestations of Sars-CoV-2 infection have been described since March 2020 and include both central and peripheral nervous system manifestations. Neurological symptoms, such as headache or persistent loss of smell and taste, have also been documented in COVID-19 long-haulers. Moreover, long lasting fatigue, mild cognitive impairment and sleep disorders appear to be frequent long term neurological manifestations after hospitalization due to COVID-19. Less is known in relation to peripheral nerve injury related to Sars-CoV-2 infection. Case presentation We report the case of a 47-year-old female presenting with a unilateral chest pain radiating to the left arm lasting for more than two months after recovery from Sars-CoV-2 infection. After referral to our post-acute outpatient service for COVID-19 long haulers, she was diagnosed with a unilateral, atypical, pure sensory brachial plexus neuritis potentially related to COVID-19, which occurred during the acute phase of a mild Sars-CoV-2 infection and persisted for months after resolution of the infection. Conclusions We presented a case of atypical Parsonage-Turner syndrome potentially triggered by Sars-CoV-2 infection, with symptoms and repercussion lasting after viral clearance. A direct involvement of the virus remains uncertain, and the physiopathology is unclear. The treatment of COVID-19 and its long-term consequences represents a relatively new challenge for clinicians and health care providers. A multidisciplinary approach to following-up COVID-19 survivors is strongly advised

Atomized nasal douche vs nasal lavage in acute viral rhinitis

Objective: To evaluate the efficacy of the atomized nasal douche in the restoration of physiological nasal functions in patients affected by acute viral rhinosinusitis, when compared with nasal lavages with isotonic sodium chloride solution. Design: Randomized clinical trial. Setting: The ENT Department at the University of Siena Medical School. Patients: Two hundred patients affected by acute viral rhinosinusitis were included in the study. Interventions: Patients were randomly divided into 2 groups: group 1 patients received an atomized nasal douche, and group 2 patients received nasal lavages with isotonic sodium chloride solution. Patients underwent treatments 4 times per day for 15 days in our institution under our direct control. Results: Atomized nasal douches significantly improved inspiratory and expiratory rhinomanometric resistance (P < .01) and nasal volumes measured by acoustic rhinometry (P < .001). Nasal lavages were unable to modify these variables significantly (P < .3). Only atomized nasal douches were able to normalize mucociliary transport time to a physiological level (P < .001). Conclusions: The atomized nasal douche demonstrated a better efficacy than traditional nasal lavages with isotonic sodium chloride solution in restoring all the physiological nasal functions. For this reason, and considering ease of use, painlessness, cheapness, and manageability of the instrument, we suggest the use of the compressor-micronizer chamber system (Rinoflow Nasal Wash & Sinus System) as a routine adjuvant to every treatment of acute rhinopathies