Risultati uditivi e fattori prognostici nell’ossiculoplastica con cartilagine in pazienti affetti da otite cronica colesteatomatosa

La cartilagine è comunemente utilizzata per la ricostruzione della membrana timpanica e dell’attico in corso di timpanoplastica. Nella nostra esperienza la cartilagine costale omologa è stata utilizzata per molti anni per la creazione di protesi ossiculari. Scopo di questo studio è stato quello di valutare i risultati funzionali dell’ossiculoplastica con condroprotesi e di identificare fattori prognostici. Abbiamo valutato pazienti affetti da otite media cronica colesteatomatosa la cui catena ossiculare è stata ricostruita mediante condroprotesi. 67 soggetti sono stati sottoposti a ossiculoplastica totale (TORP) o parziale (PORP) tra gennaio 2011 e dicembre 2013. Per la valutazione dei risultati uditivi sono state utilizzate le Linee Guida della “Committee on Hearing and Equilibrium” dell’American Academy of Otolaryngology Head and Neck. L’analisi statistica dei risultati è stata eseguita con test ANOVA e modelli di regressione lineare. Il gap via aerea-via ossea (ABG) migliorava significativamente dopo ossiculoplastica da 39,2 dB HL (DS 9,1 dB HL) a 25,4 dB HL (DS 11 dB HL) (p < 0,001). L’analisi statistica ha dimostrato che l’unico fattore prognostico è stato il tipo di tecnica chirurgica utilizzata. Infatti, i pazienti sottoposti a timpanoplastica chiusa hanno presentato miglior ABG postoperatorio rispetto alla timpanoplastica aperta (p = 0,02). Tutte le altre variabili analizzate non hanno influenzato i risultati uditivi. La cartilagine costale è il nostro materiale scelta per la creazione di protesi ossiculari quando gli ossicini autologhi non sono disponibili. La tecnica chirurgica (timpanoplastica chiusa) si è dimostrata quale unico fattore prognostico positivo

Lectures on Generalized Symmetries

These are a set of lecture notes on generalized global symmetries in quantum field theory. The focus is on invertible symmetries with a few comments regarding non-invertible symmetries. The main topics covered are the basics of higher-form symmetries and their properties including 't Hooft anomalies, gauging and spontaneous symmetry breaking. We also introduce the useful notion of symmetry topological field theories (SymTFTs). Furthermore, an introduction to higher-group symmetries describing mixings of higher-form symmetries is provided. Some advanced topics covered include the encoding of higher-form symmetries in holography and geometric engineering constructions in string theory. Throughout the text, all concepts are consistently illustrated using gauge theories as examples.Comment: 138 pages, added reference

Non-surgical management of chronic rhinosinusitis with nasal polyps based on clinical-cytological grading: a precision medicine-based approach

La rinosinusite cronica con polipi nasali (CRSwNP) è una malattia cronica nasosinusale, a eziologia infiammatoria, con significativo impatto negativo sulla qualità di vita dei pazienti. La CRSwNP rappresenta ancora oggi una sfida terapeutica per lo specialista ORL, sia per la comprensione della sua eziopatogenesi, sia per il suo controllo clinico ed è questo è testimoniato dalla alta incidenza di recidiva dopo trattamento. Abbiamo voluto verificare lipotesi che un approccio terapeutico nuovo, standardizzato, e individualizzato sul grading clinico-citologico (clinical-cytological grading CCG) consentisse un miglior controllo dei sintomi della malattia, e di ridurre la necessità di ricorrere alla chirurgia. Abbiamo pertanto reclutato 204 pazienti affetti da CRSwNP, di cui 145 hanno regolarmente assunto la terapia rispettando il protocollo proposto, e 59 pazienti, invece, che non hanno assunto la terapia in modo sistematico e sono stati quindi inclusi come controlli. Dopo 5 anni di trattamento standardizzato, abbiamo notato che 15 pazienti su 145 (10,3%) del gruppo con terapia standardizzata avevano avuto un miglioramento dello staging endoscopico, 61 su 145 (42%) si erano mantenuti costanti, mentre 69/145 (47,5%) erano andati incontro a un peggioramento. Nel gruppo di controllo, invece, i pazienti peggiorati erano ben 49 su 59 (83%), con un peggioramento significativo in termini di grading endoscopico di almeno due classi (p < 0,05). I pazienti e i controlli sono stati successivamente stratificati sulla base del CCG in 3 sottogruppi: pazienti con CCG lieve, moderata e grave. Dopo tale suddivisione in classi, è stato possibile evidenziare che nel gruppo con CCG lieve (n = 27), il 92% dei pazienti manteneva negli anni un trend costante, in assenza di peggioramenti e senza necessità di ricorrere alla chirurgia nei 5 anni di osservazione, mentre nel gruppo di controllo, 1 paziente su 59 (1,6%; p = <0,05) ricorreva a chirurgia. Nel gruppo con CCG moderato (n = 83), invece, il 44% dei pazienti standardizzati non aveva avuto un peggioramento di grading endoscopico, con un 3,6% di pazienti che aveva avuto necessità di ricorrere alla chirurgia, contro il 13,6% del gruppo controllo (p < 0,05). Nel gruppo dei pazienti con CCG grave (n = 35), anche se nessun paziente riusciva a ottenere un miglioramento del grading endoscopico, il 40% dei pazienti veniva comunque giudicato controllato da un punto di vista clinico. Nel gruppo dei pazienti con CCG grave, ben il 5,7% dei pazienti necessitava di trattamento chirurgico, ma anche in questo caso, la percentuale dei pazienti operati era significativamente maggiore (p = 0,0000) nel gruppo di controllo (49%). Infine, lanalisi statistica effettuata ha dimostrato chiaramente che, da un punto di vista obiettivo, le dimensioni dei polipi nasali tendevano ad aumentare a una velocità maggiore nel gruppo controllo che nel gruppo standardizzato, con incrementi proporzionali nelle tre classi di CCG (lieve, moderato e grave). Lo studio attuale fornisce le basi per lo sviluppo e ladozione di un nuovo approccio per la gestione della CRSwNP sulla base di uno score clinico e citologico (CCG) che permetta di stimare con accuratezza la gravità della CRSwNP e di adattarne il trattamento. Tale approccio limita luso degli steroidi sistemici alle sole classi CCG di entità moderata-grave con dosi di steroidi inferiori rispetto a quanto precedentemente suggerito in letteratura. Il nostro protocollo può migliorare pertanto laderenza terapeutica dei pazienti, il tasso di controllo della malattia e può ridurre il ricorso alla chirurgia nel corso degli anni

Cartilage ossiculoplasty in cholesteatoma surgery: hearing results and prognostic factors

Cartilage tympanoplasty is an established procedure for tympanic membrane and attic reconstruction. Cartilage has been used as an ossiculoplasty material for many years. The aim of this study was to evaluate hearing results of costal cartilage prostheses in ossicular chain reconstruction procedures in subjects operated on for middle ear cholesteatoma and to determine the presence of prognostic factors. Candidates for this study were patients affected by middle ear cholesteatoma whose ossicular chain was reconstructed with a chondroprosthesis. 67 cases of ossiculoplasty with total (TORP) or partial (PORP) chondroprosthesis were performed between January 2011 and December 2013. Follow-up examination included micro-otoscopy and pure tone audiometry. The guidelines of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology Head and Neck Surgery were followed and pure-tone average (PTA) was calculated as the mean of 0.5, 1, 2 and 4 kHz thresholds. Statistical analysis was performed with ANOVA tests and regression models. Average air-bone gap (ABG) significantly improved from 39.2 dB HL (SD 9.1 dB HL) to 25.4 dB HL (SD 11 dB HL) (p &lt; 0.001). Linear regression analysis showed that the only prognostic factor was the type of operation (p = 0.02). In fact, patients submitted to ICWT presented better post-operative ABG compared to CWDT. None of the other variables influenced the results. The present study proposes costal cartilage as material of choice when autologous ossicles are not available. The maintenance of the posterior canal wall was the only prognostic factor identified

Nasal irrigation with Nasir® in children: a preliminary experience on nasal cytology

Allergic rhinitis (AR) and upper airway respiratory infections are frequent in children, and both have a relevant impact on some social aspects, including school attendance and performance, sleep, quality of life (also of the parents), and costs. Saline nasal irrigation is widely employed to reduce nasal congestion and mucopurulent secretion, to stimulate cleansing of the nasal and paranasal cavities, and to induce restoration of mucociliary clearance. The present study evaluated the effects of nasal irrigation on nasal cytology, using the new device Nasir® in 66 children (40 males, 26 females, mean age 7.31±1.7 years, age range 4-17 years) with allergic rhinitis. The patients were treated with nasal irrigation with warm (36°C) Nasir® (250 mL sacs of premixed solution): one sac twice daily for 12 days. Nasal irrigation significantly reduced the neutrophilic infiltrate (baseline median value 2.8±0.7; post treatment value 2±0.5; p less than 0.05). In addition, there was a reduction of eosinophil infiltrate (T0= 3.2±1.1; T1= 2.6±1.2; p= less than 0.05). There was no significant change with regard to bacteria (T0= 2.7±0.9; T1= 2.3±1.02; p= 0.17). In conclusion, this pilot study reports that nasal irrigation with Nasir® might be useful to attenuate upper airway inflammation

Allergic and nonallergic rhinitis and skin sensitization to metals: is there a link?

reserved6Background. Chromium, Cobalt and Nickel are responsible for contact dermatitis, that is largely prevalent in the general population. They can act also as irritants in the upper and lower respiratory airways. Also rhinitis (allergic and nonallergic) is a high prevalence disorder. Both diseases could share some common inflammatory mechanisms, but the clinical association between skin sensitization to metals and rhinitis was never studied. Objective. We assessed the presence of skin sensitization to metals in subjects with rhinitis. Methods. Patients suffering from rhinitis underwent a standard diagnostic procedure, including skin testing, nasal endoscopy and nasal cytology. Control healthy subjects were also included. None of the patients had skin diseases. All subjects underwent patch test with Chromium, Cobalt and Nickel. Results. None of the 26 controls had positive skin prick test or nasal cytology. The 82 rhinitis patients were subdivided into allergic (group A = 27), nonallergic (group B = 31) and overlapping (group C = 24). The prevalence of positive patch test to metals was 26% in group A, 45% in group B, 42% in group C and 31% in controls. The percentage of patch-positive subjects was significantly different between Group A and B (p = 0.0045; OR: 0.43), Group A and C (p = 0.0186; OR: 0.49), and Group B and controls (p = 0.0360; OR: 1.85). There was a significant difference between groups A + controls and B + C. Conclusion. Even in the absence of skin diseases, the prevalence of sensitization to metals (patch test) is greater in nonallergic and overlapping rhinitis, as compared to allergic rhinitis and controls.mixedGelardi, M; Guarino, R; Taliente, S; Quaranta, N; Carpentieri, A; Passalacqua, GGelardi, M; Guarino, R; Taliente, S; Quaranta, N; Carpentieri, A; Passalacqua,

Allergic and nonallergic rhinitis and skin sensitization to metals: is there a link?

Background. Chromium, Cobalt and Nickel are responsible for contact dermatitis, that is largely prevalent in the general population. They can act also as irritants in the upper and lower respiratory airways. Also rhinitis (allergic and nonallergic) is a high prevalence disorder. Both diseases could share some common inflammatory mechanisms, but the clinical association between skin sensitization to metals and rhinitis was never studied. Objective. We assessed the presence of skin sensitization to metals in subjects with rhinitis. Methods. Patients suffering from rhinitis underwent a standard diagnostic procedure, including skin testing, nasal endoscopy and nasal cytology. Control healthy subjects were also included. None of the patients had skin diseases. All subjects underwent patch test with Chromium, Cobalt and Nickel. Results. None of the 26 controls had positive skin prick test or nasal cytology. The 82 rhinitis patients were subdivided into allergic (group A = 27), nonallergic (group B = 31) and overlapping (group C = 24). The prevalence of positive patch test to metals was 26% in group A, 45% in group B, 42% in group C and 31% in controls. The percentage of patch-positive subjects was significantly different between Group A and B (p = 0.0045; OR: 0.43), Group A and C (p = 0.0186; OR: 0.49), and Group B and controls (p = 0.0360; OR: 1.85). There was a significant difference between groups A + controls and B + C. Conclusion. Even in the absence of skin diseases, the prevalence of sensitization to metals (patch test) is greater in nonallergic and overlapping rhinitis, as compared to allergic rhinitis and controls

Nasal irrigation with Nasir® in children: a preliminary experience on nasal cytology

Allergic rhinitis (AR) and upper airway respiratory infections are frequent in children, and both have a relevant impact on some social aspects, including school attendance and performance, sleep, quality of life (also of the parents), and costs. Saline nasal irrigation is widely employed to reduce nasal congestion and mucopurulent secretion, to stimulate cleansing of the nasal and paranasal cavities, and to induce restoration of mucociliary clearance. The present study evaluated the effects of nasal irrigation on nasal cytology, using the new device Nasir® in 66 children (40 males, 26 females, mean age 7.31±1.7 years, age range 4-17 years) with allergic rhinitis. The patients were treated with nasal irrigation with warm (36°C) Nasir® (250 mL sacs of premixed solution): one sac twice daily for 12 days. Nasal irrigation significantly reduced the neutrophilic infiltrate (baseline median value 2.8±0.7; post treatment value 2±0.5; p less than 0.05). In addition, there was a reduction of eosinophil infiltrate (T0= 3.2±1.1; T1= 2.6±1.2; p= less than 0.05). There was no significant change with regard to bacteria (T0= 2.7±0.9; T1= 2.3±1.02; p= 0.17). In conclusion, this pilot study reports that nasal irrigation with Nasir® might be useful to attenuate upper airway inflammation

FACIAL NERVE RESTORATION AFTER VESTIBULAR SCHWANNOMA SURGERY

Abstract Facial nerve (FN) palsy represents the most frequent complication of VS surgery, therefore all of the professionals involved in the treatment of VS should be aware of its implications and treatment. Several treatments have been described for the management of facial nerve paralysis. The choice of the repair technique depends on various factors, including the type and site of lesion, the time elapsed from the injurious event, the patient’s expectations and the rehabilitation. Post-operative facial nerve paralysis can be treated with static and dynamic techniques. Static techniques are based on the passive correction of muscle deficits without restoring their movement, while dynamic techniques aim to restore the active function of the affected mimic muscles, through the restoration of the muscular innervation or their replacement with free or pedunculated muscle flap