ACTA Otorhinolaryngologica Italica

Early detection of hearing loss in older adults: the public audiology service in Italy, 2021-2023

2025-06-04T09:57:36+00:00

Objective. With the rise in life expectancy and increased age-related hearing loss (ARHL), audiological assessment is essential to enable prevention of cognitive decay associated with social isolation. This study evaluates audiological services in Italy to support future research, prevention strategies, and public health policies.
Methods. We analysed national audiological service data in Italy from 2021 to 2023, focusing on the use of pure-tone and speech audiometry. Service provision was examined in relation to population size, estimated ARHL prevalence, and availability of specialised personnel.
Results. The number of pure tone audiometry tests rose from 634,996 in 2021 to 790,245 in 2023; speech audiometry tests increased from 179,279 to 230,008, respectively. The national prevalence of pure-tone and speech audiometry tests performed in 2023 was 1340.1 x 100,000 and 390 x 100,000, respectively. Delivery of audiometry tests varied by area, with the North-East exhibiting the highest prevalence of speech audiometry tests in 2023, whereas pure tone tests were more more prevalent in the North-West of the country. The availability of audiology professionals was limited, with a just 2.16 consultant medical audiologists and 1.82 technicians per 100,000 residents.
Conclusions. The supply of audiology tests perfomed in Italy during 2021-2023 was insufficient to meet the growing demand for hearing assessments among the aging population. However, the effectiveness of any screening audiological programme depends not only on the availability of well-trained specialists, but also on effective education programmes for the general population.

The impact of a two-stage newborn hearing screening protocol for early diagnosis of hearing loss

2026-02-23T08:06:11+00:00

Objective. Early detection and prompt intervention of permanent hearing impairment (PHI) can only be achieved through universal newborn hearing screening (UNHS) in the first month of life. The most common screening protocols worldwide involve a combined approach with transient evoked otoacoustic emissions (TEOAEs) and automated auditory brainstem response (AABR). Our study aims to evaluate the proportion of infants with PHI in a population with discordant outcome TEOAEs/AABR through audiological follow-up.
Methods. The present study enrolled 637 healthy babies who failed TEOAEs at birth and were referred for a secondary level audiological evaluation with TEOAEs and AABR. Ninety babies with discordant outcome (TEOAEs refer/AABR pass) underwent audiological retest adding tympanometry and clinical click-evoked auditory brainstem response.
Results. PHI was confirmed in 12 babies (7 bilaterally and 5 unilaterally) and the degree was mild to moderate in 8 and in 4 babies, respectively. There were no risk factors for delayed onset of hearing loss in half of PHI.
Conclusions. The discordant TEOAEs refer/AABR pass suggests that follow-up should be recommended independently of risk factors for PHI to avoid misleading diagnosis of mild or late-onset hearing loss.

Beyond sentinel node biopsy: preliminary results of indocyanine green-guided neck dissection in cN0 tongue cancer

2025-09-01T13:53:19+00:00

Objective. Neck management in oral cancer is crucial, as regional involvement strongly affects survival. Elective dissection leaves out 10% of recurrences, mainly at levels IV-V or contralateral. Sentinel node biopsy is a different strategy to detect unexpected lymphatic drainage. Our aim is to develop a tumour-specific lymphatic mapping approach for locally-advanced cN0 tongue cancers by combining scintigraphy biopsy with indocyanine green (ICG) guidance.
Methods. In this multicentre prospective pilot study lymphatic drainage was evaluated preoperatively using scintigraphy and intraoperatively with ICG fluorescence. Bilateral neck dissection was first performed removing ICG enhancing nodes, then those identified by gamma probe and lastly the remaining ones.
Results. Nine patients were enrolled. Robbin’s levels mostly enhanced were IB-IIA-III (83%), followed by level IV (66%), IIB (50%) and IA (33%). The ICG method showed a sensitivity of 100%, a positive predictive value of 47% compared to lymphoscintigraphy and of 6.3% compared to metastatic nodes. A negative predictive value of 100% was observed by both.
Conclusions. A tailored lymphography-guided neck dissection could provide an effective lymphatic mapping with any individual variation allowing to overcome the limitations of sentinel biopsy and pitfalls associated with traditional elective treatment.

The prognostic impact of perioperative metabolic variables in head and neck cancer: a prospective study

2025-06-29T07:56:34+00:00

Objective. Major head and neck surgeries are associated with significant perioperative morbidity. Despite extensive metabolic parameter investigations, consistent prognostic indicators remain undefined. This study aimed to elucidate metabolic predictors for perioperative prognosis.
Methods. A prospective observational study evaluated patients undergoing major head and neck surgeries (2019-2020). Nutritional status was assessed preoperatively and on postoperative days 2 and 10 using electric bioimpedance analysis. Phase angle, a bioelectrical marker of soft-tissue mass and hydration, served as a nutritional status indicator.
Results. 37 patients were included (mean age 61.3 ± 12.5 years; 45.9% males), predominantly with oral cavity origins (75.7%). Postoperative day 10 phase angle significantly correlated with one-year survival (p = 0.014). Neutrophil-to-lymphocyte ratio (NLR) on postoperative days 2 and 10 was associated with postoperative complications (p = 0.022 and 0.026). Preoperative nutritional support demonstrated improved phase angle, optimised NLR levels, and reduced risk of complications (p = 0.023).
Conclusions. Phase angle represents a significant prognostic indicator for survival of head and neck surgical patients. Preoperative nutritional intervention shows potential in reducing complications and enhancing post-surgical metabolic outcomes.

Italian validation of the Niigata Questionnaire to assess the severity of persistent postural-perceptual dizziness

2025-11-01T11:16:45+00:00

Objective. The Niigata persistent postural-perceptual dizziness (PPPD) Questionnaire (NPQ), developed by Yagi et al. in 2019, assesses the severity of PPPD. Initially available in English, it was later adapted into Spanish, German, and Indian versions. This study aimed to validate the NPQ in Italian to provide a reliable tool for assessing severity of PPPD.
Materials and methods. Fifty PPPD patients (21 men, 29 women; aged 49-73) meeting diagnostic criteria were enrolled. Cross-cultural adaptation followed a standardised protocol with input from bilingual specialists and an expert committee. The questionnaire was administered during clinical evaluation and re-administered after one month, prior to treatment. Internal consistency and test–retest reliability were analysed using Cronbach’s alpha and Pearson’s correlation coefficients.
Results. Internal consistency was excellent (α = 0.95). Pearson’s correlation exceeded 0.80 for total, posture/gait, movement, and visual stimulation scores. Concordance for concentration was also high (0.999; 95% CI: 0.999-0.999).
Conclusions. The Italian NPQ is a valid and reliable instrument for quantifying PPPD severity. It can assist clinicians in diagnosis and follow-up, supporting monitoring of disease progression and effectiveness of treatment.

Regional and distant metastases from laryngeal chondrosarcoma: a systematic review

2025-05-26T16:01:37+00:00

Objective. Laryngeal chondrosarcomas (LCS) are rare malignancies, constituting approximately 0.5% of all primary laryngeal tumours. These predominantly slow-growing, low-grade tumors can sometimes exhibit a more aggressive clinical course with higher rates of local recurrence and possible regional and/or distant metastases. The true occurrence of metastatic LCS is not well defined in the literature due to limited and scattered data. This systematic review aims to analyse the metastatic behaviour of LCS, focusing on patterns of spread, therapeutic options, and clinical outcomes.
Methods. A systematic review was conducted according to the PRISMA guidelines searching on PubMed, Web of Science, and Scopus databases. Studies included cases of LCS with regional and/or distant metastasis.
Results. A total of 44 articles describing 53 cases of metastatic LCS were included. The mean age of patients was 63.5 years. Aggressive subtypes of LCS (high grade, dedifferentiated, and myxoid variants) accounted for 54.3% of metastatic cases. Distant metastases were observed in 71.7% of patients, with lungs being the most common site. Regional lymph nodes involvement was documented in 37.7% of cases. Surgery was the primary treatment, with total laryngectomy being the most common approach. Radiotherapy was administered as adjuvant treatment in 24.5% of patients. At last follow-up, 49% of patients had died from the disease, and 9.4% had persistent disease.
Conclusions. Although LCS is typically indolent, patients with metastatic disease present significant clinical challenges. The true metastatic rate remains uncertain due to the scattered distribution of data. Aggressive subtypes of LCS exhibit a greater propensity for metastasis, underscoring the need for closer surveillance and individualised treatment strategies.

Haemangiopericytoma and solitary fibrous tumour of the parotid gland: a scoping review

2025-05-02T14:11:52+00:00

Salivary gland tumours represent about 3-10% of head and neck tumours, with the parotid gland being the most affected. The World Health Organization classification of these tumours is continually evolving due to their diverse histology and biological behaviour. Haemangiopericytoma (HPC) and solitary fibrous tumour (SFT) have been reclassified as a single entity characterised by NAB2-STAT6 gene rearrangement, typically presenting as slow-growing, painless masses in the parotid region, and immunohistochemistry is essential for diagnosis. This study aims to examine the clinical characteristics of these tumours to better understand their biological behaviour. Following PRISMA 2020 guidelines, we reviewed the literature using the search string (haemangiopericytoma), OR (solitary fibrous tumor) AND (parotid gland). Of the initially collected 201 papers, 49 were selected for detailed analysis, focusing on data from 53 patients, all of whom underwent surgery. Of these patients, 11.3% (n = 6) were diagnosed with malignancy, while 3 more were suspected to have malignancy. Our findings suggest that SFT morphology predominates among lesions, but malignancy is more often associated with features of HPC. Further comprehensive study is needed to gather additional data on their biological behaviour.

Factors affecting the quality of life of caregivers of children with tracheostomy: an assessment tool

2025-05-16T08:30:33+00:00

Objectives. Develop and validate comprehensive questionnaire scales to investigate the quality of life (QoL) of parents caring for tracheostomised children and identify potential contributing factors.
Methods. This is a cross-sectional questionnaire conducted in paediatric otolaryngology clinics in 5 tertiary hospitals. Caregivers caring for children with tracheostomies at home between April 2023 and March 2024 were included. The survey items were divided into 4 distinct domains: (1) frequency of healthcare utilisation; (2) awareness and knowledge; (3) skills in tracheostomy care; and (4) caregiver’s QoL. Internal consistency, construct validity, and test-retest reliability were assessed.
Results. Eighty-seven caregivers completed the survey. The combined Cronbach’s α coefficient was 0.81. Exploratory factor analysis values exceeded 0.75 for most items. The awareness level, ease of obtaining tracheostomy tubes, and experience in tracheostomy care showed a significant positive association with the QoL.
Conclusions. TrachQoL questionnaire is a reliable tool that may help guide clinical interventions and future research. Scales for caregivers’ level of knowledge and skills and accessibility to healthcare services are useful for investigating QoL in families caring for children with a tracheostomy.