ACTA Otorhinolaryngologica Italica

Lateral hypopharyngectomy with laryngeal preservation reconstructed with inlay fasciocutaneous free flaps: clinical and functional outcomes

Davide Lancini — 2024-10-18

Objective. Lateral hypopharyngectomy (LH) is one of the organ-preservation surgical strategies available for treatment of selected naïve early squamous cell carcinoma (SCC), as well as for rarer non-SCC tumours and persistent/recurrent/second primaries after chemoradiation of the lateral wall of the piriform sinus. Its reconstructive methods have been the subject of different approaches without a general consensus. The aim of the present study is to describe a retrospective series of LH reconstructed by inlay fascio-cutaneous free flaps, reporting on oncological and functional outcomes.
Methods. Patients who underwent LH at the Department of Otorhinolaryngology – Head and Neck Surgery of the University of Brescia, Italy, between 2017 and 2023 were retrospectively reviewed. Clinical history, tumour histotype, postoperative complications, functional, and oncological outcomes were collected.
Results. Seven patients (6 males, 1 female) were included. In all, 29% had a treatment-naïve neoplasm, while 71% had recurrent disease. The final histology included 3 SCC, 2 synovial sarcomas, one liposarcoma, and one single-site mucosal metastasis from cutaneous melanoma. Negative margins were achieved in 6 patients (86%). All patients had swallowing rehabilitation by speech therapists and were able to safely eat a free diet at discharge, except for one who needed a percutaneous endoscopic gastrostomy to support nutritional oral intake. After a mean follow-up of 34.3 months, all patients except one are alive.
Conclusions. Our study showed that, in selected cases, it is possible to radically remove lateral hypopharyngeal tumours with laryngeal preservation and free flaps inlay reconstruction, with a low rate of complications and acceptable functional and oncological results.

In memory of Giorgio Sperati

Felice Scasso — 2024-12-19

Another great Master has left us: Giorgio Sperati, the last of that group of enthusiastic colleagues who have contributed in a decisive way to the progress of the SIOeChCF.

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https://www.actaitalica.it/article/view/912/559

Factors influencing audiologic outcomes in ossiculoplasty for chronic otitis media: a prospective multicentre study

Gianluca Fadda — 2024-12-19

Objective. Chronic otitis media (COM) is a prevalent condition affecting auditory function. Ossiculoplasty is a known treatment strategy, but its effectiveness concerning the presence of cholesteatoma has not been extensively studied.
Methods. We conducted a multicentre study involving 153 patients diagnosed with COM without cholesteatoma (ncCOM) and with cholesteatoma (cCOM). Patients underwent ossiculoplasty, and postoperative hearing outcomes were analysed.
Results. After patient selection, 133 participants were included. Postoperatively, significant improvements in hearing function were observed in both groups, substantiating the role of ossiculoplasty in treatment of COM. However, different outcomes were noted between ncCOM and cCOM. Patients with cCOM demonstrated a slightly lesser degree of hearing improvement post-surgery compared to their ncCOM counterparts.
Conclusions. Our findings confirm ossiculoplasty as a standard and effective treatment strategy for COM. The presence of cholesteatoma may influence the effectiveness of surgery, underscoring the need for individualised surgical planning. Future research should focus on confirming these results and more comprehensively exploring the impact of cholesteatoma on surgical outcomes.

Effects of face protector devices on acoustic parameters of voice

Valeria Caragli — 2024-12-19

Objectives. The SARS-CoV-2 pandemic required the use of personal protective equipment (PPE) in medical and social contexts to reduce exposure and prevent pathogen transmission. This study aims to analyse possible changes in voice and speech parameters with and without PPE.
Methods. Speech samples using different types of PPE were obtained. Recordings were then analysed using PRAAT software (version 6.1.42). Statistical analysis was conducted using ANOVA in Jamovi software. A post-hoc test was performed to compare PPE-related results.
Results. Statistically significant differences were found in Cepstral Peak of Prominence- Smoothed, Harmonic to Noise Ratio (HNR), slope of Long-Term Average Spectrum (LTAS), tilt of trendline through LTAS, shimmer parameters, HNR mean and standard deviation of vowels, vowels and consonants formants. HNR values increased whereas shimmer parameters and formant values reduced using PPE [PPE combined>filtering face piece (FFP)> surgical masks>no PPE].
Conclusions. Our data show improvement in many parameters of voice and speech quality and modification of speech articulation when using masks, particularly in case of combined PPE. The most relevant changes were found with a combination of face shield and FFP2 masks. This may be due to unconscious improvements in speech articulation and increased demand on vocal folds to achieve better speech intelligibility.

Development and validation of the Italian digit-innoise test

Pasquale Viola — 2024-12-19

Objective. This research aims to validate the digits-in-noise (DIN) test for the Italian language and develop a version capable of independently assessing both ears while maintaining acceptable administration times.
Methods. Individual digits from 0 to 9 in Italian were recorded and adjusted to equalise recognition probabilities. An iOS application (APP) was developed for the independent ear test using triplets in noise. The application incorporates a new proprietary adaptive procedure developed by Amplifon to minimise the number of steps required to determine the Speech Reception Threshold (SRT). Thirty-nine subjects were recruited for equalisation of digits, 45 normal-hearing and 62 with various degrees of hearing loss for normative-data assessment.
Results. The results demonstrate the ability to determine a threshold value for normal hearing consistent with the existing literature and identify threshold values corresponding to the main World Health Organization hearing loss categories.
Conclusions. A DIN test for the Italian language has been developed and validated to evaluate the SRT of each ear individually. The adaptive algorithm optimises the necessary steps while maintaining acceptable test duration for both ears. Users can autonomously conduct the test using a standard personal iOS device (tablet or smartphone).

A critical update on endoscopic dacryocystorhinostomy

Luca Giovanni Locatello — 2024-12-19

Objective. Endoscopic dacryocystorhinostomy (endo-DCR) is becoming a workhorse in the management of distal lacrimal duct obstruction. It yields success rates comparable to external DCR, with the advantage of no external scars. However, it requires multidisciplinary expertise and many uncertainties in terms of proper indications, technique, and perioperative management still exist.
Methods. Systematic review of the literature in the last 5 years using PubMed and Google Scholar.
Results. A total of 66 articles were included. Many technical modifications and surgical refinements have been proposed, but a formal comparison of the various techniques is hampered by methodological heterogeneity. The use of local anaesthesia and perioperative adjunctive techniques to reduce the risk of restenosis are also gaining popularity even if the level of evidence remains weak.
Conclusions. Endo-DCR offers satisfactory clinical outcomes even though there are many grey areas that need to be addressed in future high-quality studies.

Acknowledgements to our reviewers - 2024

The Editor in Chief — 2024-12-19

The Editor-in-Chief and the Editorial Board of Acta Otorhinolaryngologica Italica are extremely grateful to the Scientific Committee and all the colleagues who kindly reviewed the scientific papers submitted for publication during 2024, contributing to a meticulous selection and appropriate re-elaboration of the manuscripts:

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Low condylectomy and functional therapy alone for unilateral condylar osteochondroma treatment: case report and literature review

Domenico Sfondrini — 2024-12-19

Osteochondroma (OC) is a common bone tumour that rarely affects the mandibular condylar process. This pathology can show typical clinical features, such as facial asymmetry, deviation of the chin and dental inferior midline, changes in condylar morphology and malocclusion with an increased posterior mandibular vertical height. The management of condylar OC is a debated topic among surgeons. Most of them combine systematically condylectomy with orthognathic surgery while only few others perform in the first instance only condylectomy followed by functional therapy. A case of a 32-year-old female diagnosed with a mandibular condylar OC successfully treated with condylectomy alone is presented. A literature review is carried out focusing on surgical management, clinical and imaging features, highlighting the differences between OC and other condylar growing lesions.
When maxillary alterations are not present or are mild as in the presented patient, the low condylectomy alone, followed by elastic functional therapy, can correct both the aesthetic and the occlusal disorders resulting from condylar OC removal. In case of severe dentoalveolar maxillary compensation, orthognatic surgery must be performed with the low condylectomy to quickly correct facial symmetry and occlusion.

Maximising efficiency with exoscopic surgery: a versatile approach for transoral laryngeal and oropharyngeal procedures

Filippo Marchi — 2024-12-19

Objective. Several devices have been developed to improve head and neck surgery. 3D exoscopes provide surgeons a viable alternative to microscopes. We propose our setting for transoral exoscopic oropharyngeal (TOEOS) and transoral exoscopic laryngeal surgery (TOELS).
Methods. A case series of patients treated with the exoscopic setup at the Otolaryngology Unit of IRCCS San Martino Hospital, Genoa, is presented. Our surgical setup and surgical and oncological outcomes are described.
Results. Among 40 patients undergoing TOELS for glottic and supraglottic tumours, negative superficial and deep margins were achieved in 79.2% and 75% of patients, respectively. The mean operative time was 73.7 ± 35.9 minutes. Fourteen patients were treated by TOEOS and in only one case was re-resection required due to a positive deep margin. The mean operative time for TOEOS was 140.3 ± 82.1 minutes and the average duration of hospitalisation was 10.3 ± 3.8 days.
Conclusions. 3D exoscopes improve visualisation of the surgical site in different environments and allow the use of multiple surgical instruments and lasers, easing transoral surgery. In addition, as the first surgeon’s view is shared between the operatory room (OR) staff, the exoscopic setup plays a crucial role in the collaboration between the OR team and for teaching purposes.