Applicability of platelet- and extracellular vesicle-rich plasma for the treatment of chronic inflammations of postoperative temporal bone cavities

Poznavanje vloge zunajceličnih veziklov (ZV) v medcelični komunikaciji je vodilo pri raziskovanju izdelave pripravkov, bogatih z ZV (t. i. izolatov), ki bi jih lahko uporabljali pri diagnosticiranju in zdravljenju. Ker priprava izolatov v diagnostične in terapevtske namene ostaja izziv, smo ZV namesto v izolatih želeli uporabiti v drugih terapevtskih pripravkih. Zaradi znanih ugodnih učinkov plazme, bogate s trombociti (PBT), v regenerativni medicini in zaradi pomembne vloge ZV v njej smo zasnovali edinstven postopek priprave plazme, bogate s trombociti in zunajceličnimi vezikli (PBTZV). PBTZV je vsebovala visoke koncentracije trombocitov in ZV (M = 592 x 109/L, SD = 198 x 1012/L). Uporabili smo jo v randomizirani kontrolirani klinični raziskavi za zdravljenje bolnikov s kroničnim vnetjem pooperativne votline senčnice (KVPVS), pri katerih je bilo zaključeno kirurško zdravljenje in izčrpano standardno konzervativno zdravljenje. Ugotovili smo, da je zdravljenje s PBTZV bolj učinkovito kot standardni konzervativni načini zdravljenja, kar smo potrdili z zmanjšanjem površine KVPVS v skupini bolnikov, zdravljenih s PBTZV (p < 0,0005), in z odsotnostjo zmanjšanja KVPVS v skupini, zdravljeni s standardnimi konzervativnimi načini (p = 0,152). Uvrščenost v eno od skupin je statistično značilno vplivala tudi na kakovost življenja bolnikov med zdravljenjem, saj je seštevek točk vprašalnika o kroničnem vnetju srednjega ušesa (p < 0,0005) pokazal statistično značilne razlike med skupinama pri drugem, tretjem in četrtem pregledu ter statistično značilno boljšo kakovost življenja med prvim pregledom in tretjim pregledom ter med prvim pregledom in četrtim pregledom v skupini bolnikov, zdravljenih s PBTZV.Knowledge of the roles of extracellular vesicles (EV) in intercellular communication has led to study the production of EV-rich preparations (i.e., isolates) to be used in diagnostics or treatment. However, the preparation of EV isolates for these purposes remains a challenge. Instead of isolates, EV were intended to be used via other therapeutic preparations. Due to the known beneficial effects of platelet-rich plasma (PRP) in regenerative medicine and the important roles of EV in it, we developed a unique platelet- and extracellular vesicle-rich plasma (PVRP) preparation protocol. PVRP contained high platelet and EV concentrations (M = 592 x 109/L, SD = 198 x 1012/L) and was used in a randomized controlled clinical trial to treat patients with chronic postoperative temporal bone cavity inflammation who have undergone surgical and exhaustive standard conservative treatment. PVRP had better treatment effects compared to standard conservative methods according to reduction of inflammation area in the group of patients treated with PVRP (p < 0,0005), and the absence of this difference in the group treated with standard conservative methods (p = 0,152). In addition, the intervention group had a statistically significant effect on the patients\u27 quality of life over treatment time (p < 0,0005), due to statistically significant lower COMQ-12 (chronic otitis media questionnaire 12) score in patients treated with PVRP compared to control group at the second, third and fourth check-up. Moreover, there was COMQ-12 score improvement in patients treated with PVRP and decrease in score in control group

Prospects of Extracellular Vesicles in Otorhinolaryngology, Head and Neck Surgery

The diagnostic and therapeutic potential of extracellular vesicles (EVs) has been recognised in many fields of medicine for several years. More recently, it has become a topic of increasing interest in otorhinolaryngology, head and neck surgery (ORL-HNS). With this narrative review, we have aspired to determine different aspects of those nanometrically sized theranostic particles, which seem to have promising potential as biomarkers in some of the most common diseases of the ORL-HNS by being available via less invasive diagnostic methods. At the same time, a better understanding of their activity provides us with new possibilities for developing specific target treatments. So far, most research has been oriented towards the role of EVs in the progression of head and neck cancer, notably head and neck squamous cell cancer. Nonetheless, some of this research has focused on chronic diseases of the ears, nose and paranasal sinuses. However, most research is still in the preclinical or experimental phase. It therefore requires a further and more profound understanding of EV content and behaviour to utilise their nanotheranostic capacities to their fullest potential

Prospects of Extracellular Vesicles in Otorhinolaryngology, Head and Neck Surgery

The diagnostic and therapeutic potential of extracellular vesicles (EVs) has been recognised in many fields of medicine for several years. More recently, it has become a topic of increasing interest in otorhinolaryngology, head and neck surgery (ORL-HNS). With this narrative review, we have aspired to determine different aspects of those nanometrically sized theranostic particles, which seem to have promising potential as biomarkers in some of the most common diseases of the ORL-HNS by being available via less invasive diagnostic methods. At the same time, a better understanding of their activity provides us with new possibilities for developing specific target treatments. So far, most research has been oriented towards the role of EVs in the progression of head and neck cancer, notably head and neck squamous cell cancer. Nonetheless, some of this research has focused on chronic diseases of the ears, nose and paranasal sinuses. However, most research is still in the preclinical or experimental phase. It therefore requires a further and more profound understanding of EV content and behaviour to utilise their nanotheranostic capacities to their fullest potential

Unraveling the etiology of pediatric vertigo and dizziness

Background and Objectives: Numerous authors have reported that the commonest type of vertigo in children is migraine-associated vertigo (vestibular migraine and benign paroxysmal vertigo of childhood—BPV). We aimed to provide the possible etiological background of vertigo and dizziness in Slovenian children. Materials and Methods: A retrospective case series of pediatric vertigo and dizziness children referred to the tertiary pediatric otorhinolaryngology center from 2015 to 2020. Children received a complete audiological and vestibular workup and were referred to pediatric specialists depending on the clinical presentation. Results: Of 257 children (42% male, 58% female) aged 1–17 years (M = 10.9, SD = 4.3 years) in 19.1% vertigo and dizziness were classified as central, in 12.4% as a peripheral vestibular, in 10.9% as a hemodynamic, in 5.8% as a psychological and none as visual by pediatric neurologists, otorhinolaryngologists, cardiologists, psychologists or ophthalmologists, respectively. 40.8% (20) children with central vertigo had BPV (7.8% of all children) and 8.2% (4) migrainous vertigo. In 43.6% (112 children), the etiology remained unclassified. Conclusions: After a thorough multidisciplinary workup, the etiology of vertigo and dizziness was unraveled in the majority of children referred to our tertiary otorhinolaryngology center. The most common cause was centralhowever, in a considerable number, the etiology remained unclassified. The latter could be attributed to the self-limiting nature of vertigo spells. Hence, a child presenting with dizziness and vertigo requires a multidisciplinary approach, in which referral to a neurologist is, in most cases, essential

Slovenian Cross-Cultural Adaptation and Validation of Health-Related Quality of Life Measures for Chronic Otitis Media (COMQ-12), Vertigo (DHI, NVI) and TINNITUS (THI)

To provide physicians and patients with the tools needed to evaluate patients’ problems and health-related quality of life by cross-culturally adapting and validating the Chronic Otitis Media Questionnaire 12 (COMQ-12), the Dizziness Handicap Inventory (DHI), the Neuropsychological Vertigo Inventory (NVI) and the Tinnitus Handicap Inventory (THI)

Indicators of pediatric peripheral vestibular disorder

Objectives: This study aims to present characteristics of pediatric patients with peripheral vertigo and dizziness and their clinical workup results in the tertiary otorhinolaryngology center. We wanted to investigate whether the detailed history could replace the extensive vestibular testing and whether the clinical presentation could guide the first contact physician to appropriately directed specialist referral. Methods: Retrospective case review of consecutive pediatric vertigo and dizziness patients referred to the tertiary otorhinolaryngology center from 2015 to 2020. The data about the signs and symptoms of vertigo and dizziness and the results of audiological and vestibular tests were collected. Results: Of 257 children aged 10.9±4.3 years (R: 1–17 years), 32 (12.5%) had peripheral, and 49 (19%) had central vertigo and dizziness. Acute vestibulopathy was diagnosed in 22/257 (8.5%) children, sudden sensorineural hearing loss and benign paroxysmal positional vertigo in 5/257 (2%) children each. 60% of children with peripheral vertigo and dizziness had emesis, and 55.6% had nausea. 8% of children had spontaneous horizontal-rotatory nystagmus that followed Alexander’s law. Goodman and Kruskal’s л for determining whether the type of nystagmus could predict the type of vertigo and dizziness (central or peripheral) was 0.481 (p = 0.001). 12/26 (60%) of children with peripheral vertigo and dizziness had emesis compared to 14 (30.04%) children without emesis, a difference in proportions of 0.296 (p = 0.024, chi-square test of homogeneity). Binomial logistic regression to ascertain the effects of duration, nausea and emesis on the likelihood of the presence of peripheral vertigo was statistically significant (χ2(3) = 10.626, p = 0.014). Conclusion: Unlike adults, peripheral vestibular causes of vertigo and dizziness in children may be rare but have the same typical signs and symptoms. The detailed history and careful clinical examination are crucial in differentiating between peripheral and central causes. This guides the first contact physician for further referral to appropriate specialists included in a multidisciplinary workup. Namely, nausea, emesis, horizontal nystagmus and a longer duration of symptoms in a child with vertigo and dizziness indicate a peripheral etiology. Therefore, a referral to an otorhinolaryngologist is reasonable

Applicability of platelet- and extracellular vesicle-rich plasma in medicine

Platelet-rich plasma is a blood-derived product with proven favourable effects after a local application in various healing disorders. It is also rich with extracellular vesicles - a heterogeneous group of nano- to micro-sized membranous structures -that are considered as the main mediators of regenerative effects. Hence, the prepared blood product can be suitably named »platelet- and extracellular vesicle-rich plasma«. Platelets and platelet- derived extracellular vesicles are not only important in haemostasis, but also in the immune response. Platelets are the most numerous blood immune cells. They are also the main source of blood-derived extracellular vesicles. Extracellular vesicles play an important role in intra- and intercellular communication, therefore they can be utilised in diagnosis and treatment. Platelet- and extracellular vesicle-rich plasma is being used for almost three decades in different fields of medicine, especially in surgery, due to its favourable regenerative properties. However, extracellular vesicles are seldom described in clinical studies that consider the platelet-rich plasma. Based on the molecular mechanisms of the healing process, functions of platelets and platelet-derived extracellular vesicles, platelet- and extracellular vesicle-rich plasma offers an important therapeutic solution in different diseases. Application of platelet- and extracellular vesicle-rich plasma is inexpensive and safe, however its preparation requires advanced laboratory skills. An article contains a description of this blood product and reported experiences on its use. We also present our recent advances which are a product of a collaboration of researchers from medical and biomedical fields. This collaboration leads to an advancement in the treatment modalities in different fields of medicine, also otorhinolaryngology and cervicofacial surgery

Malignant syphilis in a female patient

Malignant syphilis (MS) is a rare form of secondary syphilis with grotesque skin lesions, systemic manifestation and life-threatening complications. This article presents a case of MS in an immunocompetent 41-year-old female, who initially manifested with a generalized nonpruritic erythematous rash and systemic symptoms. She was mistreated for generalized impetigo and hepatitis attributed to chronic alcoholism. After partial recovery and a 3-month latent period, she developed infiltrated plaques with crusts on the trunk, head and neckpharyngitis and laryngeal lesionsgeneralized lymphadenopathy and nonspecific systemic symptoms. Serologic tests confirmed syphilis, and cerebrospinal fluid analyses indicated the presence of anti-treponemal antibodies. Urine drug screening was positive for cannabinoids. The polymerase chain reaction from skin biopsy samples identified T. pallidum, confirmed with Warthin-Starry staining. Immunohistochemical analysis was uncharacteristic. Tertiary syphilis, neurosyphilis, ocular syphilis and otosyphilis were excluded. However, the patient was treated for neurosyphilis with benzylpenicillin (18 million IU intravenously daily, 14 days) and corticosteroids. No Jarisch-Herxheimer reaction occurred. Ten months after treatment, residual scars were visible, and 1 year later, she attempted suicide. Since MS can resemble other diseases, it should be suspected in a mentally ill patient with chronic drug abuse, systemic nonspecific manifestations and dermatological abnormalities, including the head and neck region

Consequences of Stapes Surgery on Tongue Morphological Characteristics in Narrow Band Imaging, Gustatory Function and General Sensation: A Prospective Tertiary Center Study

(1) Background: Chorda tympani (CT) manipulation during stapes surgery affects its functions. We hypothesized that this alters tongue morphology and sensory functions. (2) Methods: Patients undergoing stapes surgery were tested 1 day preoperatively, 1 and 6 months postoperatively. Narrow band imaging contact endoscopy (NBI) was used to determine the number of fungiform papillae (Npapillae) and the total score of blood vessel morphology (NBItotal). The taste was tested with taste strips. General sensation was tested with a static two-point discrimination. Tests were performed on ipsilateral and contralateral side of the tongue. (3) Results: 52 otosclerosis patients were included in the study. There was a statistically significant decrease of NBItotal (p = 0.005), Npapillae (p = 0.009), sensation of sweet (p = 0.003), salty (p = 0.035), sour (p = 0.036), and bitter taste (p = 0.013) within the test side during the follow-up. A statistically significant impact on presence of dysgeusia for sweet was found 1 month postoperatively (p p = 0.056). (4) Conclusions: CT manipulation affects fungiform papillae density, vascular patterns and taste sensation. The general sensation of the tongue is not influenced by CT manipulation