ACTA Otorhinolaryngologica Italica

Office-based transnasal injection laryngoplasty with cross linked hyaluronic acid in unilateral vocal fold palsy: long-term results

2025-04-25T12:28:18+00:00

Objective. To assess long-term phonatory outcomes of office-based injection laryngoplasty with cross-linked hyaluronic acid (HA) via transnasal flexible endoscopic phonosurgery (FEPS), followed by voice therapy, in patients with unilateral vocal fold palsy (UVFP).
Methods. Retrospective study on 20 UVFP patients treated with HA via FEPS within 6 months from diagnosis. All underwent postoperative voice rehabilitation. Voice outcomes were assessed at baseline (T0), and at 3 (T1), 12 (T2), and 24 (T3) months using
Maximum phonation time (MPT), Cepstral Peak Prominence Smoothed (CPPS), Acoustic Voice Quality Index (AVQI), GRBAS rating scale, and Voice Handicap Index-10 (VHI-10).
Results. MPT, CPPS, and AVQI improved significantly at T1, remaining stable at T2 and T3. GRBAS scores showed marked improvement at T3. Videolaryngostroboscopy confirmed better glottic closure and vocal fold vibration. VHI-10 scores decreased consistently, indicating reduced voice handicap.
Conclusions. FEPS-guided HA injection is a safe, effective, and minimally invasive treatment for UVFP, ensuring lasting voice improvements, especially when performed early and combined with voice therapy. This strategy may reduce the need for open surgery in selected cases.

Parent-child interaction and early pragmatic, auditory and linguistic abilities in deaf children

2025-10-24T09:46:09+00:00

Objectives. To describe the Parent-Child Interaction (PCI) in prelingually deaf children with hearing aids and cochlear implants; to evaluate correlations between PCI, parental stress and family participation in the intervention programme, as well as between PCI and auditory and spoken language abilities.
Methods. 20 children (12 males, 8 females; mean age 21.8 ± 4.2 months) received a test battery including Categories of Auditory Performance (CAP), Social Conversational Skills Rating Scale for Assertiveness (SCS-A) and for Responsiveness (SCS-R), MacArthur-Bates Communicative Development Inventories (M-BCDI). PCI was assessed by video analysis, while parental stress and family participation were assessed with the Parenting Stress Index Short Form questionnaire (PSI) and Familiar Involvement Rate Scale (FIRS), respectively.
Results. PCI style was “tutorial” in 15%, “modulated control” in 40%, “directive” in 20% and “asynchronous” in 25% of cases. A significant correlation was found between PCI and FIRS score, between PCI and CAP score, and between PCI and SCS-A rating scale score.
Conclusions. Assessment of PCI in deaf children is important because it relates to family participation in the intervention programme and affects the development of auditory and pragmatic abilities.

A systematic review and network meta-analysis of therapies for locally advanced head and neck squamous cell carcinoma with different HPV status

2025-06-16T13:44:31+00:00

Infection with high-risk human papillomavirus (HPV) is considered a major cause of head and neck squamous cell carcinoma (HNSCC). However, the optimal treatment choice remains uncertain for both HPV-positive and HPV-negative locally advanced HNSCC (LA-HNSCC) in patients who are unable to tolerate surgery. To assess the effectiveness of various treatment strategies for HPV-positive and HPV-negative LA-HNSCC, this systematic review and network meta-analysis evaluated 4 databases and identified 31 relevant studies. The selected outcomes included overall survival, progression-free survival, locoregional control, distant metastasis, and disease-free survival. Hazard ratios with 95% confidence intervals were pooled for each outcome, and treatment modality rankings were calculated using the surface under the cumulative ranking curve. We found that induction chemotherapy combined with radiotherapy and chemoradiotherapy were optimal for HPV-positive patients, while concurrent chemoradiotherapy and concurrent chemoradiotherapy combined with targeted therapy were most effective for HPV-negative patients. These findings highlight the importance of individualised treatment protocols and lay the groundwork for future clinical trials to optimise outcomes in LA-HNSCC.

Letter to the Editor in Chief regarding the paper entitled “Lateral hypopharyngectomy with laryngeal preservation reconstructed with inlay fascio-cutaneous free flaps: clinical and functional outcomes” by Lancini et al.

2025-04-14T11:24:40+00:00

To the Editor,

We read with great interest the article “Lateral hypopharyngectomy with laryngeal preservation reconstructed with inlay fascio-cutaneous free flaps: clinical and functional outcomes” by Lancini et al., recently published in Acta Otorhinolaryngologica Italica. The authors provide a commendable contribution to the surgical management of hypopharyngeal squamous cell carcinoma (HSCC) with laryngeal preservation and outline specific tumour-related criteria that must be met for their conservative approach to be feasible, i.e.; 1) unilateral hypopharyngeal lesions centred on the lateral wall of the piriform sinus, without involvement of the retrocricoid region, posterior hypopharyngeal wall, or oesophageal mucosa; 2) preserved arytenoid motility, without invasion of the cricoid and/or thyroid cartilage. We believe that a combined transoral endoscopic approach provides higher precision in delineating the superior, superolateral, and superomedial resection margins of the hypopharynx. This technique enables accurate placement of the pharyngeal opening to the neck from an inside-to-outside perspective, thereby expanding the indications for conservative surgery even when the posterior hypopharyngeal wall is involved or for tumours originating from this region. We are pleased to share our experience with two cases of HSCC affecting the posterolateral and posterior wall of the hypopharynx, which we successfully resected using a combined open and transoral endoscopic technique.

Technological refinements in transoral laser exoscopic surgery: the VITOM EAGLE

2025-01-10T10:38:57+00:00

Traditionally, microscopes have been the primary magnification tools in head and neck surgery, offering excellent illumination, augmentation, and three-dimensional (3D) visualisation. More recently, exoscopes such as the VITOM 3D from Karl Storz, have emerged. These devices utilise high-definition cameras to project 3D views onto a screen, enabling the entire surgical team to observe the procedure while the first operator assumes a more ergonomic position during surgery. VITOM 3D enhances surgical accuracy and team collaboration, although it presents challenges including difficulties with focus at high magnification and less stable coupling with adjunctive tools. To address these limitations, the VITOM EAGLE exoscope was recently introduced. Weighing 4 kg, it features a 6X optical and 2X digital zoom, 4K resolution, stepless focus adjustment, and a 90° viewing angle. It offers improved ergonomics even compared to the previous VITOM 3D, better laser coupling stability, and enhanced visualisation capabilities, especially at higher magnification. The VITOM EAGLE’s controls include an IMAGE1 PILOT, footswitch, and head buttons, managing functions like focus, zoom, brightness, and image capture. Despite its advancements, some details, like the smoothness of the robotic arm, still require refinement. In our clinical practice, several cases were managed with the use of the VITOM 3D and, more recently, with VITOM EAGLE, some of which are illustrated herein.

Notiziario SIO 2025

2025-10-24T10:35:33+00:00

CONSIGLIO DIRETTIVO SIO (2025-2026)

See full text:

https://www.actaitalica.it/article/view/1771/885

Is there a relationship between olfactory dysfunction and duration of menopause?

2025-10-24T08:47:56+00:00

Objective. The aim of this study is to compare the odour threshold and odour identification tests of women of reproductive age and postmenopausal period and to examine the relationship between the duration of menopause and olfactory dysfunction.
Methods. Eighty women of reproductive age and in the postmenopausal period were included in this prospective study. These were divided into four groups of 20 women each: Group 1, reproductive period; Group 2, postmenopausal period (0-5 years); Group 3, postmenopausal period (6-10 years); and Group 4, postmenopausal period (more than 10 years). All the women enrolled underwent complete ear, nose, and throat examinations, followed by odour threshold test and odour identification test. The results were then compared among the groups.
Results. There was a statistically significant difference between the groups in terms of age, odour threshold test and odour identification test (p < 0.001, p = 0.016, and p < 0.001, respectively). Age adjusted results indicated that there were no statistically significant difference in odour threshold test scores between groups compared to the reference group 1. However, women in group 3 were 90% less likely to have higher odour ıdentification test scores compared to women in group 1 [OR (95% CI): 0.10 (0.01-0.73); p = 0.025].
Conclusions. Olfactory dysfunction is seen in the postmenopausal period. However, this is correlated with age. Olfactory dysfunction in the postmenopausal period appears to be the result of aging together with hormonal changes.

Optimising care for chronic rhinosinusitis with nasal polyps and asthma in multimorbid patients: a multidisciplinary Delphi consensus

2025-03-21T06:34:24+00:00

Objective. Chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma often coexist and share common underlying pathophysiological mechanisms. This study addresses challenges in the diagnosis and treatment of multimorbid patients with CRSwNP and asthma providing new insights for their management.
Methods. Using a modified Delphi method, a scientific board of 40 Italian clinicians (pulmonologists, allergists/clinical immunologists, and ear, nose, and throat specialists) developed consensus statements regarding the multimorbid patient with severe CRSwNP and asthma and including the disease burden, assessment, treatment and multidisciplinary management of multimorbid patients.
Results. All statements reached consensus. Experts acknowledged the substantial disease burden, the key pathophysiological role of type 2 inflammation in multimorbid patients and the need for multidisciplinary care. The use of biologics represents a highly effective therapeutic opportunity for patients with comorbidities, optimising overall outcomes. Integrated care pathways and regular multidisciplinary reassessment were deemed essential for treatment decisions and improved care in multimorbid patients.
Conclusions. This consensus highlights the value of a multidisciplinary approach for multimorbid CRSwNP and asthma patients, advocating for endotype-driven therapies and standardised pathways in clinical practice.

Stapler-assisted total laryngectomy and hybrid primary puncture: analysis of functional results

2025-10-24T07:28:35+00:00

Objective. To describe a new surgical technique called Hybrid Primary Puncture in Stapler-assisted Total Laryngectomy and to retrospectively compare two groups of patients undergoing total laryngectomy (TL) with or without the use of stapler.
Methods. Retrospective analysis performed on 110 patients undergoing TL and voice prosthesis (VP) primary placement, divided into “stapler group” and “no-stapler group”. The two groups were compared in terms of pharyngocutaneous fistula (PCF) incidence and events related to voice rehabilitation (hypertonicity, voice quality, complications related to VP).
Results. No statistically significant difference (p > 0.05) was found in “stapler” and “no-stapler” groups analysing the incidence of PCF, the percentages of patients who developed hypertonicity and experienced complications in the use and management of the VP. Regarding the vocal quality, a Quality of Voice index of “good” was found in similar percentages of patients in the two groups. Stratifying the sample, no significant differences emerged between “stapler” vs “no-stapler” in salvage TL in any of the parameters investigated.
Conclusions. The new technique allows to exploit, without any additional risk, the potential of stapler and primary VP placement.

Evaluation of the pan-immune-inflammation value in patients with Bell’s palsy

2025-10-24T07:54:59+00:00

Objectives. Pan-immune-inflammation value is an inflammation index calculated using the parameters in a complete blood count (CBC) and has gained popularity in recent years. In this study, we aimed to examine its role in Bell’s palsy.
Methods. The study was designed as a retrospective case-control study. The study group consisted of 79 patients with Bell’s palsy. There were 158 patients in the control group. Age, gender, grade, CBC parameters and pan-immune-inflammation value were compared statistically between the groups.
Results. Leukocyte, neutrophil, platelet and pan-immune-inflammation values were significantly higher in the Bell's palsy group than in the control group (p values: < 0.001, < 0.001, 0.03, < 0.001, respectively). There was no correlation between grade of Bell’s palsy and any study parameters.
Conclusions. Our results support the theory that inflammation may be the main factor in pathogenesis, as the pan-immune-inflammation value is higher in patients with Bell’s palsy. Our results suggest that the cell group that plays a major role in this inflammation is neutrophils.