Upper Respiratory Tract Microbiome and Otitis Media Intertalk : Lessons from the Literature

Otitis media (OM) is one of the most common diseases occurring during childhood. Microbiological investigations concerning this topic have been primarily focused on the four classical otopathogens (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pyogenes) mainly because most of the studies have been conducted with culture-dependent methods. In recent years, the introduction of culture-independent techniques has allowed high-throughput investigation of entire bacterial communities, leading to a better comprehension of the role of resident flora in health and disease. The upper respiratory tract (URT) is a region of major interest in otitis media pathogenesis, as it could serve as a source of pathogens for the middle ear (ME). Studies conducted with culture-independent methods in the URT and ME have provided novel insights on the pathogenesis of middle ear diseases through the identification of both possible new causative agents and of potential protective bacteria, showing that imbalances in bacterial communities could influence the natural history of otitis media in children. The aim of this review is to examine available evidence in microbiome research and otitis media in the pediatric age, with a focus on its different phenotypes: acute otitis media, otitis media with effusion and chronic suppurative otitis media

ENT management of children with adenotonsillar disease during COVID-19 pandemic : ready to start again?

Clinical manifestations of COVID-19 in children are milder, but the real burden of disease is unknown. After the lockdown, in our Region Lombardia we have been requested to progressively resume medical services including outpatient assessment and priority surgery. Therefore, we screened surgical waiting lists with identification of 47 children candidates to priority surgery (among 358). No homogeneous national health surveillance/screening programs are ongoing or have been conceived to test susceptible population among children/healthcare workers in preparation of coming down to routinely daily activities, and diagnostic strategies are not completely accurate in children. So, restoring medical services now might be untimely

Single-Cell Photothermal Analysis Induced by MoS2 Nanoparticles by Raman Spectroscopy

Two-dimensional nanomaterials, such as MoS2 nanosheets, have been attracting increasing attention in cancer diagnosis and treatment, thanks to their peculiar physical and chemical properties. Although the mechanisms which regulate the interaction between these nanomaterials and cells are not yet completely understood, many studies have proved their efficient use in the photothermal treatment of cancer, and the response to MoS2 nanosheets at the single-cell level is less investigated. Clearly, this information can help in shedding light on the subtle cellular mechanisms ruling the interaction of this 2D material with cells and, eventually, to its cytotoxicity. In this study, we use confocal micro-Raman spectroscopy to reconstruct the thermal map of single cells targeted with MoS2 under continuous laser irradiation. The experiment is performed by analyzing the water O-H stretching band around 3,400 cm−1 whose tetrahedral structure is sensitive to the molecular environment and temperature. Compared to fluorescence-based approaches, this Raman-based strategy for temperature measurement does not suffer fluorophore instability, which can be significant under continuous laser irradiation. We demonstrate that irradiation of human breast cancer MCF7 cells targeted with MoS2 nanosheets causes a relevant photothermal effect, which is particularly high in the presence of MoS2 nanosheet aggregates. Laser-induced heating is strongly localized near such particles which, in turn, tend to accumulate near the cytoplasmic membrane. Globally, our experimental outcomes are expected to be important for tuning the nanosheet fabrication process

Sialendoscope-assisted transoral removal of hilo-parenchymal sub-mandibular stones: surgical results and subjective scores=L’asportazione transorale scialoendoscopico-assistita dei calcoli ilo-parenchimali sottomandibolari: Risultati chirurgici e soggettivi

It has been suggested that a conservative trans-oral approach to proximal and hilo-parenchymal submandibular stones (HPSMS) is a valid alternative to the more frequently used sialadenectomy. The aim of this study was to evaluate the surgical, ultrasonographic and patients' subjective outcomes of results of the trans-oral removal of HPSMS. Between January 2003 and September 2015, sialendoscope-assisted trans-oral surgery was used to remove symptomatic, large (> 7 mm), fixed and palpable HPSMS from 479 patients under general anaesthesia. All patients were followed clinically and ultrasonographically to investigate symptom relief and recurrence of stones, and were telephonically interviewed to assess saliva-related subjective outcomes with a questionnaire. Stones were successfully removed from 472 patients (98.5%); the seven failures (1.5%) concerned pure parenchymal stones. One year after the procedure, 408 patients (85.1%) were symptom free, 59 (12.3%) had recurrent obstructive symptoms and 12 (2.6%) had recurrent infections. Of the 54 patients who developed a recurrent stone (11.2%), 52 underwent a second procedure: 29 interventional sialendoscopies, two sialendoscope-assisted intra-corporeal pneumatic lithotripsy, eight secondary trans-oral surgery to remove residual stones, six a cycle of extra-corporeal lithotripsy and seven submandibular sialadenectomy. Most patients (75.2%) reported mild surgery-related pain. The symptoms of 454 patients (94.8%) improved after adjunctive treatment and, at the end of follow-up, the affected gland was preserved in 98.5% of patients. A sialendoscope-assisted trans-oral removal of large HPSMS is a safe, effective, conservative surgical procedure, and functional preservation of the main duct and parenchyma of the obstructed gland allows sialendoscopic access through the natural ostium in case of recurrence. Combining a trans-oral approach with other minimally invasive, conservative procedures ensures symptomatic relief and salivary duct system clearance in the majority of patients

MR Imaging in Sudden Sensorineural Hearing Loss. Time to Talk

SUMMARY: Sudden sensorineural hearing loss is defined as acute hearing loss of the sensorineural type of at least 30 dB over 3 contiguous frequencies that occurs within a 72-hour period. Although many different causative factors have been proposed, sudden sensorineural hearing loss is still considered "idiopathic" in 71%–85% of cases, and treatments are empiric, not based on etiology. MR imaging implemented with a 3D FLAIR sequence has provided new insights into the etiology of sudden sensorineural hearing loss. Herein, we review the current management trends for patients with sudden sensorineural hearing loss, from the initial clinical diagnosis to therapeutic strategies and diagnostic work-up. We focused primarily on MR imaging assessment and discuss the relevance that MR imaging findings might have for patient management, pointing out different perspectives for future clinical research

Endoscopic adenoidectomy in children with otitis media with effusion and mild hearing loss

Objectives. Surgical management of children with chronic otitis media with effusion (OME) includes tympanostomy tube insertion or adenoidectomy, alone or with myringotomy and tube insertion. The aim of this study was to compare the effectiveness of transoral microdebrider endoscopic-assisted adenoidectomy (TOMEA) and traditional adenoidectomy in the management of children with mild hearing loss due to OME and chronic adenoiditis. Methods. This prospective, double-blind and controlled study involved 120 consecutive patients aged 4–12 years, who were randomised 1:1 to undergo TOMEA or traditional adenoidectomy under general anesthesia. All the patients underwent a complete otolaryngological examination, including nasopharyngeal fibre endoscopy (NFE), pneumatic otoscopy, otomicroscopy, tympanometry and supraliminar tonal audiometry, upon enrolment, and three and nine months postoperatively. Results. There were no statistically significant differences in age or gender distribution between the TOMEA group (mean age, 4.9±1.1 years; 53.3% males) and the traditional adenoidectomy group (mean age, 5.3±0.9 years; 56.7% males). Both procedures led to a significant improvement in choanal patency (P<0.01) and all of the otological and audiological parameters (P<0.01) 3 and 9 months postoperatively, although postoperative NFE showed that the mean percentage of residual choanal obstruction was significantly less in the TOMEA group (P=0.02). There was no significant between-group difference in the percentage of children with tympanic membrane changes, but the postoperative prevalence of children with a type B tympanogram was significantly lower in the TOMEA group after 3 (15.0% vs. 31.7%, P=0.05) and 9 months (18.3% vs. 38.3%, P=0.02), as was the percentage of children with mild conductive hearing loss (3.3% vs. 23.3%, P<0.01; and 8.3% vs. 28.3%, P<0.01). Conclusion. Although both TOMEA and traditional adenoidectomy are effective in treating children with mild hearing loss due to adenoidal hypertrophy and OME, the former achieves the greater reduction in residual adenoidal hypertrophy and better audiological outcomes

Endoscopic adenoidectomy in children with otitis media with effusion and mild hearing loss

Objectives. Surgical management of children with chronic otitis media with effusion (OME) includes tympanostomy tube insertion or adenoidectomy, alone or with myringotomy and tube insertion. The aim of this study was to compare the effectiveness of transoral microdebrider endoscopic-assisted adenoidectomy (TOMEA) and traditional adenoidectomy in the management of children with mild hearing loss due to OME and chronic adenoiditis. Methods. This prospective, double-blind and controlled study involved 120 consecutive patients aged 4\u201312 years, who were randomised 1:1 to undergo TOMEA or traditional adenoidectomy under general anesthesia. All the patients underwent a complete otolaryngological examination, including nasopharyngeal fibre endoscopy (NFE), pneumatic otoscopy, otomicroscopy, tympanometry and supraliminar tonal audiometry, upon enrolment, and three and nine months postoperatively. Results. There were no statistically significant differences in age or gender distribution between the TOMEA group (mean age, 4.9\ub11.1 years; 53.3% males) and the traditional adenoidectomy group (mean age, 5.3\ub10.9 years; 56.7% males). Both procedures led to a significant improvement in choanal patency (P<0.01) and all of the otological and audiological parameters (P<0.01) 3 and 9 months postoperatively, although postoperative NFE showed that the mean percentage of residual choanal obstruction was significantly less in the TOMEA group (P=0.02). There was no significant between-group difference in the percentage of children with tympanic membrane changes, but the postoperative prevalence of children with a type B tympanogram was significantly lower in the TOMEA group after 3 (15.0% vs. 31.7%, P=0.05) and 9 months (18.3% vs. 38.3%, P=0.02), as was the percentage of children with mild conductive hearing loss (3.3% vs. 23.3%, P<0.01; and 8.3% vs. 28.3%, P<0.01). Conclusion. Although both TOMEA and traditional adenoidectomy are effective in treating children with mild hearing loss due to adenoidal hypertrophy and OME, the former achieves the greater reduction in residual adenoidal hypertrophy and better audiological outcomes

Modern management of paediatric obstructive salivary disorders: long-term clinical experience

I disordini ostruttivi salivari sono infrequenti nelletà pediatrica. I recenti progressi tecnologici nel distretto della testa e del collo hanno modificato la strategia diagnostica e terapeutica dei disordini salivari. La diagnosi è oggi basata sulleco color Doppler, sulla scialo-RMN, sulla cone beam 3D TC, mentre la litotrissia extracorporea ed intracorporea, la scialoendoscopia interventistica, la chirurgia scialoendoscopico- assistita, sono attualmente utilizzati come procedure conservative e mininvasive per la preservazione funzionale della ghiandola affetta. Abbiamo analizzato i risultati dellesperienza clinica a lungo termine nel trattamento dei disordini ostruttivi delletà pediatrica. Un gruppo consecutivo di 66 pazienti pediatrici (38 femmine) con sintomi salivari ostruttivi causati da parotite ricorrente pediatrica (32 pazienti), calcoli (20), stenosi duttali (5), e ranule (9) è stato incluso nello studio. 45 pazienti sono stati sottoposti a scialoendoscopia interventistica per parotite ricorrente, calcoli e stenosi, 12 pazienti sono stati sottoposti ad un ciclo di litotrissia extracorporea (ESWL), tre pazienti a chirurgia transorale scialoendoscopico-assistita, un paziente a drenaggio, sei a marsupializzazione e due a sutura della ranula. Nel 90,9% è stato raggiunto un risultato favorevole. Lapproccio combinato di litotrissia salivare extracorporea e di scialoendoscopia interventistica è stato utilizzato in tre pazienti ed una procedura secondaria è stata eseguita in sette pazienti. Nessun paziente è stato sottoposto a scialoadenectomia nonostante la persistenza di modesti sintomi ostruttivi in sei pazienti. Non è stata osservata alcuna complicanza maggiore. Adottando un adeguato iter diagnostico mediante eco color Doppler delle ghiandole salivari, scialo-RMN e cone beam 3D TC, i pazienti pediatrici con disordini ostruttivi salivari possono essere efficacemente trattati con un approccio moderno mini-invasivo mediante tecniche di litotrissia extracorporea ed intracorporea, scialoendoscopia interventistica, e chirurgia transorale scialoendoscopico-assistita; questo approccio garantisce un risultato favorevole nella maggior parte dei pazienti evitando così il ricorso alla scialoadenectomia invasiva e mantenendo così la preservazione funzionale della ghiandola coinvolta

Interventional sialendoscopy for radioiodine-induced sialadenitis: quo vadis?

La tossicità delle ghiandole salivari rappresenta un noto effetto indesiderato dello iodio radioattivo (I) utilizzato per il trattamento di neoplasie tiroidee, con una prevalenza che varia dal 2% al 67% della popolazione esposta. Recentemente, la scialoendoscopia è stata introdotta come un interessante strumento diagnostico e terapeutico per la gestione dei pazienti affetti da scialoadenite radioiodio-indotta non responsiva ai trattamenti medici standard. Lobiettivo della presente revisione è stato valutare linfluenza di questa procedura sulla storia clinica di pazienti affetti da scialoadenite conseguente a trattamento con radioiodio. Complessivamente, la revisione ha incluso 8 studi, 122 pazienti e 264 scialoendoscopie. Le stenosi duttali ed i tappi mucosi hanno rappresentato l85.7% dei reperti endoscopici, sostenendo il ruolo dellostruzione duttale nella fisiopatologia della scialoadenite da radioiodio. Circa l89.3% dei pazienti riportarono una risoluzione parziale o completa degli episodi di scialoadenite ricorrente, senza complicanze post-operatorie maggiori. Un solo caso è stato sottoposto a parotidectomia per fallimento del trattamento scialoendoscopico e persistenza dei sintomi. Tuttavia, i risultati della letteratura riguardarono principalmente valutazioni soggettive e solamente in due esperienze cliniche furono prese in considerazione misure oggettive con risultati discordanti. La xerostomia fu analizzata in pochi studi, con benefici differenti rispetto ai sintomi ostruttivi. La tempistica ideale per la videoendoscopia delle ghiandole salivari necessita di ulteriori analisi, al fine di definire la miglior gestione delle scialoadeniti ostruttive radioiodio-indotte