Effect of surgery, delivery device and head position on sinus irrigant penetration in a cadaver model

AbstractObjectiveThe extent of surgery, the type of device used and head position may influence nasal irrigation. The aim of this study was to determine the effectiveness of topical irrigant delivery to the paranasal sinuses according to these factors.MethodFour cadaveric heads underwent four stepwise endoscopic dissections. Irrigations were evaluated after every stage using different delivery devices (squeeze-bottle, gravity-dependent device and syringe) in two head positions (nose-to-sink and vertex down). Irrigant penetration into each sinus was estimated using a four-point scale.ResultsA significant positive effect of surgery was demonstrated for each sinus as well as for the delivery device. High-volume irrigant devices are more effective, and the head position plays a significant role in irrigant distribution to the frontal sinus.ConclusionThis study further confirms the efficacy of high-volume irrigant devices. A vertex down position during the irrigation could improve delivery to the frontal sinus, and the widening of the ostia increases irrigant access to the sinuses

Development of LGAD sensors with a thin entrance window for soft X-ray detection

We show the developments carried out to improve the silicon sensor technology for the detection of soft X-rays with hybrid X-ray detectors. An optimization of the entrance window technology is required to improve the quantum efficiency. The LGAD technology can be used to amplify the signal generated by the X-rays and to increase the signal-to-noise ratio, making single photon resolution in the soft X-ray energy range possible. In this paper, we report first results obtained from an LGAD sensor production with an optimized thin entrance window. Single photon detection of soft X-rays down to 452~eV has been demonstrated from measurements, with a signal-to-noise ratio better than 20.Comment: 10 pages, 6 figure

Characterization of iLGADs using soft X-rays

Experiments at synchrotron radiation sources and X-ray Free-Electron Lasers in the soft X-ray energy range ($250$eV--$2$keV) stand to benefit from the adaptation of the hybrid silicon detector technology for low energy photons. Inverse Low Gain Avalanche Diode (iLGAD) sensors provide an internal gain, enhancing the signal-to-noise ratio and allowing single photon detection below $1$keV using hybrid detectors. In addition, an optimization of the entrance window of these sensors enhances their quantum efficiency (QE). In this work, the QE and the gain of a batch of different iLGAD diodes with optimized entrance windows were characterized using soft X-rays at the Surface/Interface:Microscopy beamline of the Swiss Light Source synchrotron. Above $250$eV, the QE is larger than $55\%$ for all sensor variations, while the charge collection efficiency is close to $100\%$. The average gain depends on the gain layer design of the iLGADs and increases with photon energy. A fitting procedure is introduced to extract the multiplication factor as a function of the absorption depth of X-ray photons inside the sensors. In particular, the multiplication factors for electron- and hole-triggered avalanches are estimated, corresponding to photon absorption beyond or before the gain layer, respectively.Comment: 16 pages, 8 figure

Endoscopic sinus surgery for foreign body extraction in an adult patient

Abstract Foreign bodies are an unusual indication for endoscopic sinus surgery. If outpatient extraction is not possible and acute sinusitis ensues, thorough exploration and extended surgical dissection should be considered to clear the nasal cavities

Cross-cultural Adaptation and Validation of the Voice Handicap Index Into Italian

Objectives. To evaluate the internal consistency, reliability, and clinical validity of the Italian version of the Voice Handicap Index (VHI). Study Design. Cross-sectional survey study was carried out. Methods. One hundred and seventy-five patients with voice disorders, divided in four groups according to the etiology of the disease (neurogenic, structural, functional, and inflammatory), and 84 asymptomatic subjects were included in the study. Internal consistency was analyzed through Cronbach alpha coefficient. For the VHI test-retest reliability analysis, the Italian VHI was filled twice by 56 patients and 56 control subjects. The test-retest reliability was assessed through the Pearson correlation test. For the clinical validity assessment, the scores obtained in the pathological group were compared with those found in asymptomatic individuals through the Kruskal-Wallis test. Also, the correlation between VHI and the grade of voice disorder was assessed. Finally, the effect of age and gender on overall VHI and its three subscales was analyzed. Results. Optimal internal consistency was found (alpha = 0.93); the test-retest reliability in both groups was high (r > 0.86). Nonparametric Kruskal-Wallis analysis of variance for the overall VHI score and its three domains revealed a significant main effect for group (P = 0.000). The control group scored significantly lower than the four groups of voice-disordered patients. The overall VHI score positively correlated with the grade of voice disorder (r = 0.43). In the voice-disorder group, age and gender were not correlated to the overall VHI score and to their three domains. Conclusion. The Italian VHI is highly reproducible, and exhibits excellent clinical validity

Cross-cultural adaptation and validation of the SNOT-22 into Italian

The aim of this study is\uc2\ua0to evaluate the reliability and validity of the Italian SNOT-22 (I-SNOT-22). The study consisted of five phases: item generation, reliability analysis, normative data generation, validity analysis and responsiveness analysis. The item generation phase followed the five-step, cross-cultural, adaptation process of translation and back-translation. A group of 222 patients with chronic rhinosinusitis (CRS) were enrolled for the internal consistency analysis. Sixty patients completed the I-SNOT-22 twice, 2\uc2\ua0weeks apart, for test\ue2\u80\u93retest reliability analysis. A group of 119 asymptomatic subjects completed the I-SNOT-22 for normative data generation. I-SNOT-22 scores obtained by CRS patients and asymptomatic subjects were compared for validity analysis. I-SNOT-22 scores were correlated with Lund-Mackay and visual analogue scale (VAS) scores in 50 CRS patients for criterion validity analysis. Finally, I-SNOT-22 scores obtained in a group of 59 CRS patients before and after surgical treatment for CRS were compared for responsiveness analysis. All the enrolled subjects managed to complete the I-SNOT-22 without needing any assistance. Internal consistency was satisfactory (\uce\ub1\uc2\ua0=\uc2\ua00.86). Test\ue2\u80\u93retest reliability was also satisfactory (ICC\uc2\ua0=\uc2\ua00.85). A significant difference in the I-SNOT-22 scores between the CRS patients and the asymptomatic subjects was found (p\uc2\ua0<\uc2\ua00.008). Positive significant correlations were found between I-SNOT-22 and VAS scores, while no significant correlations were found between I-SNOT-22 scores and Lund\ue2\u80\u93Mackay scores. I-SNOT-22 scores obtained in the pre-treatment condition were significantly higher than those obtained after surgery. I-SNOT-22 is reliable, valid, responsive to changes in QOL, and recommended for clinical practice and outcome research

Treatment of relapsing functional and organic dysphonia: a narrative literature review

Information about failure and relapses is critical in deciding whether and how to treat a given condition, as well as during patient counselling before therapy. This paper aims to perform a non-systematic review of relapses and failure of dysphonia treatment in the adult population. Studies on failure and relapses after treatment of benign vocal fold lesions, functional dysphonia and neurogenic dysphonia were analysed. The frequency and the duration of follow-up were heterogeneous, and the management of relapses was reported in only a portion of the studies. Relapses after surgical treatment of benign vocal fold lesions ranged between 1% and 58% of cases, and their management was mainly surgical. Rates of relapse after voice therapy for functional dysphonia and spasmodic dysphonia were 12%-88% and 8%-63%, respectively. Rates of relapse after surgical treatment for unilateral and bilateral vocal fold paralysis were 10%-39% and 6%-25%, respectively; treatment was mainly represented by surgical revision. In conclusion, failure and relapses of functional and organic dysphonias after therapy are not rare, but treatment modalities are seldomly reported. The data from this non-systematic review stresses the need for further research in this area

Italian version of the Brief Questionnaire of Olfactory Disorders (Brief-IT-QOD)

Objective. To evaluate the reliability and validity of the Italian version of the Brief Questionnaire of Olfactory Disorders (Brief-IT-QOD). Methods. The study consisted of six phases: item generation, reliability analysis (112 dysosmic patients for internal consistency analysis and 61 for test-retest reliability analysis), normative data generation (303 normosmic subjects), validity analysis (comparison of Brief-IT-QOD scores of healthy and dysosmic subjects and scores correlation with psychophysical olfactory testing TDI and SNOT-22 scores), responsiveness analysis (10 dysosmic chronic rhinosinusitis with nasal polyps patients before and after biologic therapy), and cutoff value determination (ROC curve analysis of Brief-IT-QOD sensitivity and specificity). Results. All subjects completed the Brief-IT-QOD. Internal consistency (& alpha; > 0.70) and test-retest reliability (ICC > 0.7) were acceptable and satisfactory for both questionnaire subscales. A significant difference between dysosmic and control subjects was found in both subscales (p < 0.05). Significant correlations between subscales scores and TDI and SNOT-22 scores were observed. Brief-IT-QOD scores before treatment were significantly higher than after biological therapy. Conclusions. Brief-IT-QOD is reliable, valid, responsive to changes in QoL, and recommended for clinical practice and outcome research