Centripetal Endoscopic Sinus Surgery (CESS) in pazienti con Triade di Samter: outcome chirurgico e qualita della vita.

Negli ultimi 25 anni, le innovazioni tecnologiche hanno permesso un’ ampia diffusione della chirurgia endoscopica dei seni paranasali. L’intervento considerato ormai lo standard per il trattamento delle patologie nasosinusali sin dagli anni ’90 è la FESS, che prevede un approccio mediale e inferiore. A partire dagli anni ’80, il Dr. Alexander Felippu ha sviluppato un diverso approccio al trattamento della patologia nasosinusale, basato sulla dissezione centripeta e sulla resezione en-bloc della patologia. Lo scopo di questo studio è di valutare l’outcome chirurgico e funzionale della chirurgia endoscopica nasosinusale mediante tecnica centripeta (CESS) in pazienti con poliposi nasale nell’ambito di triade di Samter. Materiali e metodi: E’ stato condotto uno studio retrospettivo esaminando i dati di 19 pazienti affetti da triade di Samter. Il campione è stato selezionato tra 146 pazienti con rinosinusite cronica, con o senza polipi, sottoposti a chirurgia endoscopica con tecnica centripeta (CESS)presso l’Hospital General Universitario Gregorio Marañon di Madrid, tra il 2006 e il 2012. In ogni visita nel follow-up post-operatorio è stata registrata in cartella clinica la percezione soggettiva dell’ostruzione nasale e della capacità olfattoria usando la Visual Analogue Scale (VAS). Infine, a Novembre 2015, è stata eseguita un’intervista telefonica a 17 dei 19 Pazienti con Triade di Samter, somministrando loro la versione spagnola del questionario SNOT-22. Risultati: Riportiamo i dati di 19 pazienti, 9 femmine e 10 maschi, di età media 50 anni. Il tempo di follow-up medio è stato di 58 mesi. Sette pazienti hanno richiesto terapia di recupero corticosteroidea per via sistemica mediamente a 47 mesi dalla chirurgia. In quattro pazienti è stato necessario reintervento di CESS: in 2 casi si trattava di revisione, in un caso di mucocele sfenoidale e in un altro di mucocele frontale. La somministrazione del questionario SNOT-22, avvenuta mediamente a 76 mesi dall’intervento chirurgico, ha mostrato uno score totale medio di 21,1. Confrontando il punteggio medio di tutte le rilevazioni VAS per l’olfatto nel post-operatorio con il valore pre-operatorio, nell’11% abbiamo riscontrato un peggioramento soggettivo, mentre l’89% dei pazienti ha presentato un miglioramento. Il sintomo di ostruzione nasale, rilevato attraverso la VAS, invece è migliorato in tutti i pazienti. Conclusioni: Nella poliposi nasale associata ad asma e intolleranza all’ASA, dove la patologia nasosinusale tende ad essere particolarmente estesa e con spiccata tendenza alla recidiva, la chirurgia endoscopica endonasale con tecnica centripeta si è dimostrata una tecnica sicura e efficace. La CESS è in grado di garantire un buon controllo della patologia a lungo termine, relativamente a qualità della vita, limitato ricorso alla terapia medica corticosteroidea e necessità di revisione chirurgica

Activity of coenzyme Q 10 (Q-Ter multicomposite) on recovery time in noise-induced hearing loss

A potential consequence of exposure to noise is a temporary reduction in auditory sensitivity known as temporary threshold shift (TTS), which mainly depends on the intensity and duration of exposure to the noise. Recovery time is related to the amount of initial hearing loss, and the most recovery takes place during the first 15 min following exposure. This study evaluated the efficacy in otoprotection against noise-induced hearing loss of an orally administrated food supplement containing coenzyme Q 10 -Ter. This water-soluble formulation of coenzyme Q 10 shows better bioavailability than the native form and has been found to have a protective effect on outer hair cells after exposure to noise in animal models. Thirty volunteers were enrolled, and the right ear of each subject was exposed to a narrow-band noise centered at 3 kHz for 10 min at the intensity of 90 dB HL. In the 30 subjects enrolled, TTS was evaluated after 2, 15, and 30 min and the recovery time was recorded in each subject. The longest recovery time was 45 min. Among the 18 subjects who underwent a second test after treatment with Q-Ter, the mean recovery time was 31.43 min. The results of the present study show that 30 days′ treatment with Q-Ter can aid faster recovery after exposure to noise (P < 0.0001). The reduction in the recovery time following treatment can be explained by Q-Ter-mediated improvement of the outer hair cells′ response to oxidative stress

The International Study of the Allergic Rhinitis Survey: outcomes from 4 geographical regions

Cingi, Cemal/0000-0003-3934-5092WOS: 000434471200007PubMed: 29423374Background: Allergic rhinitis (AR) is a global health problem and is characterised by one or more symptoms, including sneezing, itching, nasal congestion and rhinorrhea. Objective: We investigated the features of AR and the physician's approach to the management of AR patients in four geographical regions. Methods: In this cross-sectional study, a questionnaire survey concerning AR was completed by Honorary and Corresponding Members of the Italian Society of Rhinology from different countries among 4 world geographical regions-Asia, Europe, the Americas, and Africa. Results: The prevalence of AR was reported to be 15%-25%. Children and adolescents, as well as young adults, were the age groups more affected by AR with comorbidities of asthma, sinusitis, conjunctivitis, and nasal polyposis. Nasal symptoms of AR were more intense in the spring (51.92%) and autumn (28.85%). The most common aero-allergens were pollen and mites (67.31%), animal dander and pollutants (23.08%), and fungal allergens (21.15%). Allergen-specific immunotherapy was prescribed for both perennial and seasonal allergens (32.69%) via sublingual swallow (46.15%) and subcutaneous (32.69%) routes. For the AR patients, the most prescribed drugs were intranasal corticosteroids (86.54%) and oral H-1-antihistamines (82.69%). Conclusion: A network of experts can improve our knowledge concerning AR epidemiology, and together with guidelines, could assist practitioners and otolaryngologists in standardising the diagnosis and treatment of AR

Photobiomodulation for Lowering Pain after Tonsillectomy: Low Efficacy and a Possible Unexpected Adverse Effect

Background: Tonsillectomy is one of the most common surgical procedures performed in children as a treatment for obstructive sleep apnea due to tonsil hypertrophy or highly recurrent tonsillitis. Odynophagia, associated with food refusal for the first few days, is a common post-operative complaint. Available drugs for pain management, while efficacious, present some drawbacks, and a novel strategy would be welcome. Photobiomodulation (PBMT), in this context, can represent a possible choice, together with pharmacological therapy. The aim of this study was to evaluate PBMT effects compared to standard pain therapy on nociceptive sensation at different time points and administration of painkiller. Methods: A registered, controlled, randomized, double-blind clinical trial was performed. Twenty-two patients were recruited and divided into laser-treated (T) or untreated (UT) groups, based on random assignment. In T group, immediately after tonsillectomy, performed with cold dissection technique, laser light was applied to the surgery site (using a Cube 4 from Eltech K-Laser s.r.l., Treviso, Italy), and then hemostasis was performed using bismuth subgallate paste. In C group, the same procedure was performed, except that laser light was switched off. The primary outcome was the difference in pain scores between subject receiving photobiomodulation (PBMT) and subjects receiving standard care after 24 h; the secondary outcomes were pain scores at awakening and at 48 h together with distress (delirium) at awakening. Results: Two patients from the T group experienced a post-surgery bleeding, and one of them required revision of the hemostasis under general anesthesia. A preliminary analysis of pain sensation reported by the patients or caregivers did not show differences between treated and untreated subjects. Conclusion: These data suggest that PBMT could increase post-surgical bleeding

Second asymptomatic carotid surgery trial (ACST-2) : a randomised comparison of carotid artery stenting versus carotid endarterectomy

Background: Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings: Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86-1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91-1·32; p=0·21). Interpretation: Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable