ACTA Otorhinolaryngologica Italica

Cochlear implant procedure. Italian Clinical Practice Guidelines of the Italian Society of Otorhinolaryngology (SIOeChCF) and Italian Society of Audiology and Phoniatrics (SIAF). Part 1: cochlear implants in adults

Stefano Berrettini — 2025-03-14

Objective. Cochlear implant (CI) is a well-established treatment for adults with sensorineural hearing loss and without benefit from hearing aids. The Italian guidelines date back 15 years; given the expansion of indications for CI, including single side deafness and asymmetrical hearing loss, it became necessary to establish updated guidelines.
Methods. Thirteen experts and 2 patient representatives selected the key questions and drew up recommendations. The document was developed following GRADE methodology. The methodological team of the Mario Negri Pharmacological Research Institute performed systematic reviews for each question and supported the overall process.
Results. Five key questions were identified and recommendations formulated, with subgroups and considerations on implementation.
Conclusions. Though the systematic research of scientific literature found a scarcity of randomised trials and an overall poor conduct and reporting quality of primary studies and systematic reviews, strong or conditional recommendations in favour of CI have been formulated for different subgroups of patients. Further studies should enrol a larger number of participants and use consistent instruments to evaluate hearing outcomes, in order to increase the comparability of results and data pooling with meta-analysis.

Role of body mass index as a predictor of dupilumab efficacy in patients with severe chronic rhinosinusitis with nasal polyps

Letizia Nitro — 2025-03-14

Objective. Response to dupilumab for chronic rhinosinusitis with nasal polyps, albeit almost always excellent, is still not predictable. Our study focuses on the role of body mass index (BMI) on the efficacy of dupilumab.
Methods. We present a retrospective multicentre study of 106 patients on dupilumab, stratified in 3 subgroups of BMI. The main therapeutic outcomes investigated were Nasal Polyp Score (NPS), Sino-Nasal-Outcome Test - 22 (SNOT-22), Sniffin’ Sticks Identification test and visuo-analogical scale, and the different timing of response, according to De Corso et al. criteria.
Results. Dupilumab treatment led to a progressive improvement for all outcomes at all time points. Comparing the different metabolic subgroups, a late response in terms of decrease in NPS was observed only in 3 obese patients. A significant decrease was also found in SNOT-22 score at 6 and 12 months, which was less marked in overweight/obese patients.
Conclusions. Our study confirmed the efficacy of dupilumab in each BMI subgroup. However, the efficacy seems to follow different timing with respect to patients’ BMI. Our data suggest that patients with a compromised metabolic state present more severe disease at baseline and a possibly delayed response to dupilumab.

Blood and local nasal eosinophilia in chronic rhinosinusitis with nasal polyps: prevalence and correlation with severity of disease

Eugenio De Corso — 2025-03-14

Objective. The aim of this study was to evaluate the clinical relevance of absolute eosinophil blood count and eosinophil count by nasal cytology in the context of real-life clinical practice and to determine if they correlate with the severity of symptoms in patients with chronic rhinosinusitis with nasal polyps (CRSwNP).
Methods. We enrolled 425 patients with CRSwNP followed between January 2015 and April 2023 at the A. Gemelli Hospital Foundation-IRCCS, Rome, Italy. We gathered data on blood and local eosinophil count and correlated the results with clinical features. All patients underwent endoscopy, Visual Analogical Scale (VAS) for main symptoms, and SinoNasal Outcome Test 22 (SNOT-22).
Results. We observed significantly higher mean levels of eosinophils in serum and at nasal cytology in patients with CRSwNP and comorbidities (asthma, non-steroidal anti-inflammatory drugs - exacerbated respiratory disease and allergy) compared to those without. Blood eosinophilia was not associated with severity of symptoms, whereas patients with nasal eosinophil count > 5 eosinophils per high-power field at nasal cytology had a significantly higher median specific VAS for nasal symptoms and significantly higher SNOT 22 scores.
Conclusions. We demonstrated that blood eosinophil count and nasal cytology may represent useful tools in routine clinical practice to define Type 2 inflammation and that their levels are usually higher in patients with comorbidities. We also showed that blood eosinophilia was not correlated with severity of symptoms, whereas local eosinophil count was associated with high severity of symptoms and high burden on quality of life.

Prognostic value of changes in pre- and postoperative inflammatory blood markers in HPV-negative head and neck squamous cell carcinomas

Tommaso Mazzocco — 2025-03-14

Objective. Neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) are inflammatory markers easily obtained from a routine complete blood count, and their preoperative values have recently been correlated with oncological outcomes in patients with HPV-negative head and neck squamous cell carcinoma (HNSCC). The aim of this study is to evaluate the prognostic value of NLR and LMR before and after treatment in patients with HPV-negative HNSCC undergoing up-front surgical treatment.
Methods. This multicentric retrospective study was performed on a consecutive cohort of patients treated by upfront surgery for HPV-negative HNSCC between April 2004 and June 2018. Only patients whose pre- and postoperative NLR and LMR were available were included. Their association with local, regional and distant failure, progression-free survival (PFS) and overall survival (OS) was calculated.
Results. A total of 493 patients (mean age 68 years) were enrolled. The mean follow-up time was 54 months. Pre-surgical NLR ≥ 3.76 was associated with a high risk of regional failure (HR = 2.21, 95% CI: 1.08-5.55), disease progression (HR = 1.55, 95% CI: 1.07-2.25) and death (HR = 1.40, 95% CI: 0.94-2.10). A post-surgical LMR < 2.92 had a significant impact on disease progression (HR = 1.92, 95% CI: 1.13-3.28) and OS (HR = 2.98, 95% CI: 1.53-5.81). Patients with stable NLR ≥ 3.76 in the pre- and postoperative period had worse OS and PFS.
Conclusions. Our results support that pre- and postoperative NLR and LMR can be useful in identifying patients at risk of local, regional, or distant recurrence who may require closer follow-up or more aggressive treatment.

Complete response of laryngeal papillomatosis after HPV vaccination

Alberto Paderno — 2024-10-18

Complications in 2000 adult and paediatric cochlear implants: what to expect and when

Vittoria Sykopetrites — 2025-03-14

Objective. To identify the incidence of intra- and postoperative complications of adult and paediatric cochlear implants (CIs) in a large cohort with long follow-up.
Methods. Retrospective chart analysis of 2000 consecutive cases of CI in a single institution.
Results. 8.9% of paediatric CIs developed a complication after a mean period of 5.5 ± 5.8 years. 12% of adult CIs developed a complication after a mean period of 3.5 ± 5.3 years. Seroma was the most frequent paediatric complication (1.8%), after a mean of 8.9 ± 5.4 years, while vertigo was the most common complaint in adults (2.5%), emerging in the first year. Both complications were generally managed conservatively. Acute otitis media or abscess with extrusion of the receiver/stimulator required surgical revision, with or without CI explantation, in 23.5% and 76.9% of cases, respectively. Cholesteatoma or chronic otitis media were always treated surgically and required CI explantation in 86.7% of cases. All cases complicated by device failure (1.2% and 0.8% of paediatric and adult CIs, respectively) were treated with CI explantation and reimplantation, and emerged after a mean of 5 ± 4 years.
Conclusions. Knowledge and decades long monitoring of the complications related to CIs are fundamental.

Bama pig is a suitable animal for studying laryngopharyngeal reflux disease

Qingyang Shi — 2025-03-14

Objective. To assess the suitability of Bama pigs as a model for laryngopharyngeal reflux disease (LPRD) research.
Methods. Sixteen 8-month-old male Bama pigs underwent esophageal manometry to determine the precise anatomical positioning of the upper (UES) and lower esophageal sphincters (LES) relative to the incisor teeth, as well as their respective contraction intensities. The pigs were randomly allocated into three experimental groups (n = 6, 5, 5), with each group subjected to Dx PH-probe monitoring. In Group 1, animals were fasted for 24 hours and water-deprived for 6 hours before undergoing pH monitoring under anaesthesia. Group 2 was anaesthetised two hours post-normal feeding and subsequently monitored. Group 3 also received anaesthesia two hours after eating but were monitored in an awake state.
Results. The mean distance from the UES to the incisor teeth was found to be 19.8 ± 1 cm, while the LES was located at 40 ± 2.5 cm. The resting pressure measurements revealed a mean value of 64 ± 12 mmHg for the UES and 20 ± 4 mmHg for the LES in Bama pigs. Laryngopharyngeal pH values across the three groups were 7 ± 0.6, 7 ± 0.5, and 7.4 ± 1.2, respectively, showing no significant differences or reflux events. Similarly, there was no statistically significant difference in the lower oesophageal pH between Group 1 and Group 2.
Conclusions. The Bama pig emerges as a suitable animal model for studying LPRD, given its comparable physiological parameters. The feasibility of establishing a reflux model in Bama pigs and using it to investigate the underlying mechanisms of LPRD is convincingly supported by these findings.

Spontaneous neck haemorrhage secondary to parathyroid adenoma: description of a case and systematic review

Alberto Vito Marcuzzo — 2025-03-14

Introduction. Parathyroid adenomas can rarely cause spontaneous haemorrhage, which can be life-threatening. Diagnosis is challenging. We present a case and systematic review to define a clearer pattern of symptoms, diagnosis, and treatment.
Materials and methods. We conducted a literature search of PubMed, Google Scholar, and Embase using PRISMA guidelines, identifying 38 relevant case reports on spontaneous neck bleeding or haematoma caused by parathyroid adenomas from 1974 to 2020. Data included epidemiology, clinical features, and treatment. One patient treated at our clinic is described.
Results. Reviewing 38 articles, we found cervical haematomas from spontaneous bleeding of parathyroid adenoma in 45 patients, comprising 33 women and 12 men. Common symptoms were neck pain, dysphagia, and swelling. Surgery was the primary treatment, with 4.4% requiring tracheotomy. Average hospital stay was 12.5 days, which was mostly complication-free.
Conclusions. Parathyroid adenoma haemorrhage in middle-aged women with neck swelling, pain, and swallowing difficulty should be suspected. Diagnosis involves blood tests and contrast CT. Treatment is adenoma removal, typically without major complications.