Evaluation of Surgical and Functional Outcomes of Supracri- coid Laryngectomy and Rehabilitation Protocols

Abstract

Laryngeal squamous cell carcinoma (LSCC) is the most common malignant neoplasms of the head and neck. Several treatment options exist for LSCC according to cancer location and stage at diagnosis; proposed treatments include surgery alone or in combination with chemotherapy and radiotherapy. In selected LSCC cases in the T2-T4 staging, supracricoid laryngectomy (SCL) is an organ-sparing surgical approach aimed at preserving the main laryngeal functions that has been proposed as an alternative to total laryngectomy. Rehabilitation for swallowing and respiratory functions plays a central role after SCL; functional outcomes after SCL may significantly vary among different centers but they are generally satisfactory when oncological radicality has been obtained and the rehabilitation protocol starts promptly. In this clinical review, we analyzed functional outcomes for swallowing and voice rehabilitation in patients after SCL, as well as the optimal SCL surgical technique, post-operative complications and comparison with total laryngectomy or radio-chemotherapy protocols.

Can a causal relationship be established between acoustic neuroma and occupational exposure to non-ionizing radiations from mobile devices? Comparison between scientific literature data and medico-legal methodology

BACKGROUND

Over the process of establishing the causal relation-ship, medical and legal methodologies may be at variance over the definitional standards and terminologies applied, which can hinder the activities of expert witnesses.

OBJECTIVES

The article's authors have set out to assess whether, and under what conditions, a causal relationship can be established between acoustic neuroma and exposure to non-ionizing radiation from mobile communication devices.

METHODS

The study design is a Systematic Review. The authors have drawn upon a 2020 Turin Court of Appeals ruling which found such a causal relationship in a somewhat peculiar case: rare tumor and exposure to non-ionizing radiation of unusually long and regular dura-tion. The case presents several peculiarities, herein analyzed in light of a) scientific evidence relative to the etiopathogenesis of the neuroma; b) available medico-legal literature defining causality evaluation criteria, and lastly c) court filings in regard to the probability standards applied to prove causal relationship.

RESULTS

A direct tie cannot be proven, not even in cases of sub-stantially intense and lengthy exposure, if the medico-legal standards applied are not consistent enough to prove that nexus is more likely than not.

DISCUSSION

Several elements suggest a causal relationship is unlikely: a) a dearth of evidence on humans; b) rats exposed to such radiation have developed cardiac tumors, not in their ears; c) exposure has caused no tumors in mice; d) the length of exposure is incompat-ible with tumor size and type. That fourth point only concerns the case herein explored, whereas the first three have a general scope of validity. The main limitation of the present study design is the heterogeneity among the included studies. Retrospective and prospective studies have been included, which may be a source of bias.

Drugs inducing hearing loss, tinnitus, dizziness and vertigo: an updated guide

OBJECTIVE

The awareness of audio-vestibular side effects of drugs, such as hearing loss, tinnitus, dizziness and vertigo, has widely increased in the recent years. The present guide represents an update of the previous documents published by the authors in 2005 and 2011 on drug-induced ototoxicity and vestibulotoxicity.

MATERIALS AND METHODS

The authors performed a comprehensive analysis of audio-vestibular side effects of commercially available drugs based on the British National Formulary, a pharmaceutical reference book that contains a wide range of useful information and advice on prescription and pharmacology.

RESULTS

Commercially available drugs and their active principles have been classified based on their audio-vestibular side effects, as reported by the pharmaceutical companies and/or health agencies. Drugs have been categorized based on the field of application, the therapeutic indication and the pharmacological properties.

CONCLUSIONS

General practitioners, otolaryngology, neurology and audiology specialists should be aware of possible audio-vestibular side effects of drugs, such as hearing loss, tinnitus, dizziness and vertigo. The present guide represents a practical tool to rapidly identify potential audio-vestibular side effects of drugs as reported by the pharmaceutical companies and/or health agencies.

Impact of COVID-19 pandemic on otolaryngology, ophthalmology and dental clinical activity and future perspectives

OBJECTIVE

Since the COVID-19 outbreak, otolaryngologists, ophthalmologists and dentists have been severely affected, both for the transmission routes and for the diagnostical and therapeutic procedures typical of these disciplines.

MATERIALS AND METHODS

In this article, we discuss the transmission routes, the potential risk of contagion for patients and healthcare providers during procedures, and comment on the changes that will affect head and neck clinical practice in the future of outpatient and surgical activities.

RESULTS

Otolaryngologists, ophthalmologists and dentists are at high risk for infection contagion and spread because they perform diagnostic and therapeutic procedures that generate aerosol and droplets thus facilitating virus transmission. Furthermore, examination involves close doctor-patient contact and otolaryngologists and dentists have to remove patient's protective devices during the visit.

CONCLUSIONS

Special attention to prevention protocols for diagnostic and therapeutic procedures and the use of protective equipment is of utmost importance to limit contagion and prevent a new virus spread in the near future.

The role of nasal cytology in the diagnosis of allergic and non-allergic rhinitis in adult and children

OBJECTIVE

Chronic rhinitis is a common disease with an incidence of 40% in the Western population. Allergic rhinitis (AR) affects half of the adult population, while in children prevalence of AR vs. non-allergic rhinitis (NAR) of 3-4:1 is reported. Nasal cytology is the diagnostic test that has made it possible to clarify the cellular population of the nasal mucosa. The aims of the present study were to define the distribution of chronic rhinopathy in adult and pediatric populations, to classify "cellular" NAR into subgroups based on cytological features, and to identify overlapped rhinitis (OR).

PATIENTS AND METHODS

A retrospective study was conducted on 907 patients, divided into two groups: 135 children (69 females and 66 males, average age 9.8 years (range 4-17) and 772 adults (392 females and 380 males, average age 45.28 years (range 18-90). All patients with a suspicion of rhinopathy were submitted to nasal endoscopy, Skin Prick test (SPT), dosage of serum specific IgE, CT scan of nasal, and sinusal structures when chronic rhinosinusitis was suspected.

RESULTS

In the adult population of the study, 61% presented a diagnosis of chronic rhinitis: 213 patients (45.2%) had AR, 31 (6.6%) OR, and 227 (48.2%) NAR (77.5% of these patients presented a pattern of "cellular" NAR). In the pediatric population, 83% patients presented a rhinopathy: 61 (54.5%) with AR, 38 (34%) with NAR, and 13 (11.5%) with OR. Within the NAR group, 71% had a "cellular" pattern.

CONCLUSIONS

Nasal cytology is a tool that provides a more precise differential diagnosis of chronic rhinitis through the study the of nasal mucosa and the identification of "cellular" NAR and OR, even in the pediatric population.

The olfactory function in patients with common variable immunodeficiency

AIMS

To determine the incidence of olfactory dysfunction in common variable immunodeficiency patients. To evaluate the correlation between olfactory dysfunction and chronic rhinosinusitis in this class of patients.

MATERIALS AND METHODS

Fifty patients, with a diagnosis of common variable immunodeficiency and under immunoglobulin replacement therapy, were submitted to an otolaryngology physical examination and a CT scan of the craniofacial structures in order to show the presence of signs of chronic rhinosinusitis. An olfactory function evaluation was executed using the Sniffin' Sticks Test, with assessment of olfactory threshold, discrimination, identification and overall composite scores (TDI: threshold-discrimination-identification score).

RESULTS

An olfactory dysfunction was found in 23 (46%) common variable immunodeficiency patients, with hyposmia and anosmia respectively present in 65% and 38% of them. The mean TDI score in the study group was 27.7. Common variable immunodeficiency patients with CRS presented a more suggestive increase of the olfactory threshold, discrimination and identification compared to those without chronic rhinosinusitis.

CONCLUSION

In conclusion, patients with common variable immunodeficiency seem to suffer from olfactory disorders more than healthy people. One of the causal factors could be considered the presence of rhinosinusal pathologies.

Olfactory evaluation in obstructive sleep apnoea patients

The sense of smell has a high impact on the quality of life. The aim of the present study was to investigate olfactory dysfunction in patients with obstructive sleep apnoea syndrome (OSAS) and correlate the severity of disease with olfactory dysfunction. The relationships between nasal obstruction, nasal mucociliary cleareance and olfactory tests were also evaluated. Sixty patients with a diagnosis of OSAS were enrolled and underwent olfactory function evaluation. In all patients olfactory performance was tested with the Sniffin' Sticks method. Mucociliary transport times and anterior rhinomanometry were performed to identify eventual nasal obstruction and deficits in nasal mucociliary clearance. Olfactory dysfunction was present in 22 (36.6%) patients of the study group: of these, hyposmia was present in 19 (86.4%) and anosmia in 3 (13.6%). The mean TDI score in the study group was 30. A strong correlation between the olfactory dysfunction and severity of sleep apnoea measured using the AHI was found. Patients with OSA would seem to have a high incidence of olfactory dysfunction. The degree of olfactory dysfunction appears to be related to the severity of disease. However, other co-factors such as nasal obstruction and reduced mucociliary clearance might also play a role in of the aetiology of this condition.

Seasonal characterisation of maritime traffic and the relationship with cetacean presence in the Western Mediterranean Sea

Seasonal maritime traffic was investigated in relation to cetaceans, through direct observations (July 2013-June 2015) along three fixed transects in Western Mediterranean. Visually obtained vessel abundance was compared with Automatic Identification System data to explore if the two methods provided different results. Traffic intensity and composition were characterised by seasons and vessel categories. Finally, cetacean presence was investigated in relation to traffic by measuring the difference of vessel abundance in the presence and absence of animal sightings. Results showed that visual sampling was consistent with AIS data, providing more information on small-medium vessels. Traffic was more intense and diverse in Spring/Summer, and the highest vessel abundance and seasonal variations in composition emerged for inshore subareas. The difference of traffic in the presence and absence of cetaceans was higher in most offshore subareas in Spring/Summer, verified for B. physalus and S. coeruleoalba; in inshore waters, mostly occupied by T. truncatus, no significant differences emerged.

Cetacean response to summer maritime traffic in the Western Mediterranean Sea

Maritime traffic is one of many anthropogenic pressures threatening the marine environment. This study was specifically designed to investigate the relationship between vessels presence and cetacean sightings in the high sea areas of the Western Mediterranean Sea region. We recorded and compared the total number of vessels in the presence and absence of cetacean sightings using data gathered during the summer season (2009-2013) along six fixed transects repeatedly surveyed. In locations with cetacean sightings (N = 2667), nautical traffic was significantly lower, by 20%, compared to random locations where no sightings occurred (N = 1226): all cetacean species, except bottlenose dolphin, were generally observed in locations with lower vessel abundance. In different areas the species showed variable results likely influenced by a combination of biological and local environmental factors. The approach of this research helped create, for the first time, a wide vision of the different responses of animals towards a common pressure.