Project Description

Abstracts of the articles in this issue

Diagnostic tools in rhinology: the importance of the stratification

Authors: Francesco Missale, Carobbio Andrea, Claudio Sampieri, Giorgio Peretti, Frank Rikki Canevari, Francesco Mazzola.

Department of Otorhinolaryngology-Head and Neck Surgery, University of Genova, Italy

Rhinitis and rhinosinusitis represent a significant health problem in modern society cause their increasing frequency as well as their substantial financial burden on society 1,2. An accurate investigation of upper airways disorders is extremely important for several reasons 3,4. The first one is related to the quality of life of patients; the second is that a late diagnosis can lead to severe disorders. The third is associated with the fact that an upper respiratory tract may extend to the lower tract if not correctly treated.
An accurate and precise diagnosis of nasal disease should be fundamental for ENT surgeon as well as for allergist, chest physicians, and pediatricians. A lot of diagnostic tools have been described, and their applicability, specificity, and sensitivity were classified in 2011 with a Position Paper by the EAACI 5.
The ideal diagnostic tool should be straightforward to use, have high specificity and sensitivity and a low cost.
In this paper, we will describe the diagnostic techniques available in rhinology considering their utility and applicability. Not all the diagnostic techniques must be used in every patient, but the diagnostic route should be planned on the basis of the symptoms and the efficacy of the therapeutic strategies using the concept of stratification to avoid unnecessary e and expensive exams 1. For these reasons, we divided the exams into different levels of complexity.

Nasal cell vitality: the pidotimod activity in elderly with recurrent respiratory infection

Authors: A.Macchi , P. Terranova, E. Sica, A. Preti, P.G. Castelnuovo

ENT Clinic University of Insubria, Asst Sette Laghi Varese, Italy

Recurrent respiratory infections (RRI) are a widespread, increasing problem, especially for elder age. Nasal cell functionality represents the first-line defense against pathological agents coming from an external environment and cellular morphology and activity can be easily demonstrated by a simple examination like microscopic nasal cytology, and this can give important information on patients’ clinical status. The possibility of acting on behalf of repairing or enhancing cellular damages, especially of the nasal mucosa, allows creating an effective barrier against external assaults. The present study has shown that an immunostimulant like Pidotimod can interact
at a cellular level, enhancing cellular functionality and cellular vitality inside nasal
mucosa, allowing a significant reduction in the number of recurrent respiratory tract infection in elders age.

New strategies for the treatment of post-radiation toxic effects in rhinopharyngeal carcinoma patients

Authors: Elena Cantone (1), Alberto Macchi (2)

Department of Neuroscience, ENT section, “Federico II” University, Naples (1), Italy, ORL Clinic University of Insubria, Varese, Italy (2)

Rhinopharyngeal carcinoma is a tumor with a high risk of distant metastases associated with the Epstein-Barr virus. Although its aggressiveness, numerous patients are cured with standard therapy and for early stages of the disease, radiation therapy is the standard treatment. The toxic effects of radiation therapy as xerostomia, mucositis, dysphagia, hypogeusia or dysgeusia can affect the nutritional and psychological status decreasing the quality of life of patients. This study aims at evaluating the effect of the combination of serratiopeptidase, bromelain, methylsulfonylmethane and vitamin C in the prevention and treatment of toxic effects after radiation therapy for rhinopharyngeal cancer.
The study was carried out on 32 (18 M, 14 F) outpatients (mean age 60,3±5,5) with histologically proven rhinopharyngeal carcinoma undergoing radiation therapy.
Patients were divided into two groups, the first received nystatin, sodium bicarbonate, prednisone and a combination of serratiopeptidase, bromelain, methylsulfonylmethane and vitamin C. The second nystatin, sodium bicarbonate, prednisone alone.
Patients underwent nasal endoscopy, Sf-36 questionnaire, and Visual Analogue Scale questionnaires before radiation therapy, halfway through the treatment and a month after the suspension of radiation therapy.
Our data demonstrated that the combination of serratiopeptidase, bromelain, methylsulfonylmethane, and vitamin C improves the toxic effects of radiation therapy in patients with rhinopharyngeal cancer. Moreover, this association improved the general quality of life without side effects.

Endoscopic endonasal approach for resection of a large olfactory schwannoma with extension to the anterior skull base

Authors: Cambi C. (1), Seccia V. (2), Dallan I. (3), Scarano M. (4), Cristofani-Mencacci L. (5)

Christina Cambi, Resident, Otolaryngology Unit, University Hospital of Pisa (1)
Veronica Seccia, Ph.D., Otolaryngology Unit, University Hospital of Pisa (2)
Iacopo Dallan, MD, ENT Audiology and Phoniatric Unit, University Hospital of Pisa (3)
Mariella Scarano, Resident, Otolaryngology Unit, University Hospital of Pisa (4)
Lodovica Cristofani-Mencacci, MD, ENT Audiology and Phoniatric Unit, University Hospital of Pisa (5)

Objective The achievement of a fully endoscopic endonasal approach for the resection of a large
olfactory schwannoma with extension to the anterior skull base.
Methods A case of a large benign schwannoma originating from the olfactory groove is reported. Surgical treatment is considered the treatment of choice to achieve long-term success. In this report, we describe the positive surgical outcome after a fully endoscopic endonasal procedure for large tumor and the advantages and disadvantages of this kind of approach. Conclusion. We report the case of a large olfactory schwannoma completely resected with an endoscopic endonasal approach. Reconstruction was performed with a double nasoseptal flap. To date, this is one of the largest olfactory schwannoma that has been resected with a fully endoscopic endonasal approach.
Keywords olfactory groov schwannoma, endonasal approach, endoscopic approach, skull base