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Teggi R, Colombo B, Cugnata F, Albera R, Libonati GA, Balzanelli C, Casani AP, Cangiano I, Familiari M, Lucisano S, Mandalà M, Neri G, Pecci R, Bussi M, Filippi M. Phenotypes and clinical subgroups in vestibular migraine: a cross-sectional study with cluster analysis. Neurol Sci 2024; 45:1209-1216. [PMID: 37845481 DOI: 10.1007/s10072-023-07116-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVE The aim of this multicentric cross-sectional study was to collect phenotypes and clinical variability on a large sample of 244 patients enrolled in different university centers in Italy, trying to differentiate subtypes of VM. BACKGROUND VM is one of the most frequent episodic vertigo characterized by a great clinical variability for duration of attacks and accompanying symptoms. Diagnosis is based only on clinical history of episodic vertigo in 50% of cases associated with migrainous headache or photo/phonophobia. METHODS We enrolled in different university centers 244 patients affected by definite VM according to the criteria of the Barany Society between January 2022 and December 2022. An audiometric examination and a CNS MRI were performed before inclusion. Patients with low-frequency sensorineural hearing loss were not included, as well as patients with an MRI positive otherwise that for microischemic lesions. Patients were asked to characterize vestibular symptoms choosing among (multiple answers were allowed): internal vertigo, dizziness, visuo-vestibular symptoms/external vertigo; onset of vertigo and duration, neurovegetative, and cochlear accompanying symptoms (hearing loss, tinnitus, and fullness during attacks) were collected as well as migrainous headache and/or photo/phonophobia during vertigo; autoimmune disorders were also analyzed. A bedside examination was performed including study of spontaneous-positional nystagmus with infrared video goggles, post head shaking ny, skull vibration test, and video head impulse test. RESULTS We included 244 subjects, 181 were females (74.2%). The age of onset of the first vertigo was 36.6 ± 14.5 while of the first headache was 23.2 ± 10.1. A positive correlation has been found between the first headache and the first vertigo. The mean duration of vertigo attacks was 11 ± 16 h. We carried on a cluster analysis to identify subgroups of patients with common clinical features. Four variables allowed to aggregate clusters: age of onset of vertigo, duration of vertigo attacks, presence of migrainous headache during vertigo, and presence of cochlear symptoms during vertigo. We identified 5 clusters: cluster 1/group 1 (23 subjects, 9.4%) characterized by longer duration of vertigo attacks; cluster 2/group 2 (52 subjects, 21.3%) characterized by absence of migrainous headache and cochlear symptoms during vertigo; cluster 3/group 3 (44 subjects, 18%) characterized by presence of cochlear symptoms during vertigo but not headache; cluster 4/group 4 (57 subjects, 23.4%) by the presence of both cochlear symptoms and migrainous headache during vertigo; cluster 5/group 5 (68 subjects, 27.9%) characterized by migrainous headache but no cochlear symptoms during vertigo. CONCLUSION VM is with any evidence a heterogeneous disorder and clinical presentations exhibit a great variability. In VM, both symptoms orienting toward a peripheral mechanism (cochlear symptoms) and central ones (long lasting positional non-paroxysmal vertigo) may coexist. Our study is the first published trying to characterize subgroups of VM subjects, thus orienting toward different pathophysiological mechanisms.
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Affiliation(s)
- Roberto Teggi
- ENT Div., San Raffaele Scientific Institute, Vita e Salute University, Milan, Italy.
| | - Bruno Colombo
- Div. of Neurology, San Raffaele Scientific Institute, Vita e Salute University, Milan, Italy
| | - Federica Cugnata
- University Centre for Statistics in the Biomedical Sciences (CUSSB), Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Albera
- Dipartimento di Scienze, Chirurgiche Università di Torino, Turin, Italy
| | | | - Cristiano Balzanelli
- Department of Otolaryngology, University of Brescia, Spedali Civili, Brescia, Italy
| | - Augusto Pietro Casani
- Department of Otorhinolaryngology, Pisa University Medical School Otorhinolaryngology, Pisa University Medical School, Pisa, Italy
| | - Iacopo Cangiano
- ENT Div., San Raffaele Scientific Institute, Vita e Salute University, Milan, Italy
| | - Marco Familiari
- ENT Div., San Raffaele Scientific Institute, Vita e Salute University, Milan, Italy
| | - Sergio Lucisano
- Dipartimento di Scienze, Chirurgiche Università di Torino, Turin, Italy
| | - Marco Mandalà
- Otology and Skull Base Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Giampiero Neri
- Department of Neurosciences, Imaging and Clinical Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Rudi Pecci
- Unit of Audiology, Department of Surgical Sciences and Translational Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Mario Bussi
- ENT Div., San Raffaele Scientific Institute, Vita e Salute University, Milan, Italy
| | - Massimo Filippi
- Div. of Neurology, San Raffaele Scientific Institute, Vita e Salute University, Milan, Italy
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Martellucci S, Castellucci A, Malara P, Ralli G, Pagliuca G, Botti C, Gallo A, Ghidini A, Asprella Libonati G. Is it possible to diagnose Posterior Semicircular Canal BPPV from the sitting position? The role of the Head Pitch Test and the upright tests along the RALP and LARP planes. Am J Otolaryngol 2022; 43:103474. [PMID: 35561430 DOI: 10.1016/j.amjoto.2022.103474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/25/2022] [Accepted: 05/01/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE The diagnosis of benign paroxysmal positional vertigo (BPPV) involving the posterior semicircular canal (PSC) is traditionally entrusted to positioning tests where patients are rapidly brought in the supine position. This prospective study aims to define the role of a diagnostic protocol for PSC-BPPV including only upright tests. MATERIALS AND METHODS 109 patients with PSC-BPPV were enrolled. The Head Pitch Test (HPT) was carried out first. If uneventful, the patient's head was turned 45° to each side and bent back-and-forth along the plane aligning either with the right anterior-left posterior (RALP) or left anterior-right posterior (LARP) canals, thus performing the upright RALP / upright LARP (uRALP/uLARP) test. Nystagmus observed was used to predict the diagnosis, which was therefore confirmed by Dix-Hallpike tests. RESULTS PSC-BPPV could be correctly diagnosed in 75.2% of cases with the sole HPT and in 87.2% of cases by adding the uRALP/uLARP test (Upright Protocol). The time elapsed from symptoms onset was closely related to the protocol sensitivity, as it reached 100% (64/64) in acute patients while decreased to 68.9% (31/45) in cases evaluated after 7 days (p < 0.001). CONCLUSIONS Upright maneuvers could correctly diagnose PSC-BPPV in most cases. uRALP/uLARP test demonstrated to improve the sensitivity of the HPT, mainly in recent-onset BPPV.
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Libonati GA, Martellucci S, Castellucci A, Malara P. Minimum Stimulus Strategy: A step-by-step diagnostic approach to BPPV. J Neurol Sci 2022; 434:120158. [DOI: 10.1016/j.jns.2022.120158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/15/2021] [Accepted: 01/13/2022] [Indexed: 11/29/2022]
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Martellucci S, Castellucci A, Malara P, Pagliuca G, Clemenzi V, Stolfa A, Gallo A, Libonati GA. Spontaneous Jamming of Horizontal Semicircular Canal Combined with Canalolithiasis of Contralateral Posterior Semicircular Canal. J Audiol Otol 2021; 26:55-60. [PMID: 33562956 PMCID: PMC8755438 DOI: 10.7874/jao.2020.00507] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/17/2020] [Indexed: 11/22/2022] Open
Abstract
Spontaneous canalith jam is an uncommon form of benign paroxysmal positional vertigo mimicking acute vestibular neuritis. We described for the first time a spontaneous horizontal semicircular canalith jam associated with a typical canalolithiasis involving contralateral posterior semicircular canal (PSC), illustrating how the latter condition modified direction-fixed nystagmus during head movements. An 81-year-old woman with persistent vertigo referred to our center. Video-Frenzel examination showed horizontal direction-fixed right-beating nystagmus in primary gaze position, inhibited by visual fixation. She exhibited corrective saccades after leftward head impulses. Chin-to-chest positioning at the head-pitch test did not modify spontaneous nystagmus, whereas slight torsional components with the top pole of the eye beating toward the right ear appeared in backward head-bending, resulting in mixed horizontal-torsional nystagmus. At supine positioning tests, direction-fixed nystagmus turned into direction-changing geotropic horizontal nystagmus, which was stronger on the left side, while overlapping upbeat nystagmus with torsional right-beating components appeared on the right. Primary clinical findings were consistent with a left horizontal semicircular canalith jam, inducing a persistent utriculofugal cupular displacement, combined with a typical right-sided PSC-canalolithiasis. Once canalith jam crumbled, resulting in a non-ampullary arm canalolithiasis of the horizontal semicircular canal, both involved canals were freed by debris with appropriate repositioning procedures.
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Affiliation(s)
| | - Andrea Castellucci
- ENT Unit, Arcispedale Santa Maria Nuova, AUSL-IRCCS, Reggio Emilia, Italy
| | - Pasquale Malara
- Audiology and Vestibology Service, Centromedico Bellinzona, Bellinzona, Switzerland
| | | | - Veronica Clemenzi
- ENT Unit, Santa Maria Goretti Hospital, AUSL Latina, Italy.,Department of Sense Organs, Sapienza University of Rome, Italy
| | - Andrea Stolfa
- ENT Unit, Santa Maria Goretti Hospital, AUSL Latina, Italy.,Department of Sense Organs, Sapienza University of Rome, Italy
| | - Andrea Gallo
- ENT Unit, Santa Maria Goretti Hospital, AUSL Latina, Italy.,Department of Sense Organs, Sapienza University of Rome, Italy
| | - Giacinto Asprella Libonati
- U.O.S.D. "Vestibologia e Otorinolaringoiatria" Presidio Ospedaliero "Giovanni Paolo II", Policoro, Italy
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Martellucci S, Malara P, Castellucci A, Pecci R, Giannoni B, Marcelli V, Scarpa A, Cassandro E, Quaglieri S, Manfrin ML, Rebecchi E, Armato E, Comacchio F, Mion M, Attanasio G, Ralli M, Greco A, de Vincentiis M, Botti C, Savoldi L, Califano L, Ghidini A, Pagliuca G, Clemenzi V, Stolfa A, Gallo A, Asprella Libonati G. Upright BPPV Protocol: Feasibility of a New Diagnostic Paradigm for Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo Compared to Standard Diagnostic Maneuvers. Front Neurol 2020; 11:578305. [PMID: 33329319 PMCID: PMC7711159 DOI: 10.3389/fneur.2020.578305] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/23/2020] [Indexed: 11/13/2022] Open
Abstract
Background: The diagnosis of benign paroxysmal positional vertigo (BPPV) involving the lateral semicircular canal (LSC) is traditionally entrusted to the supine head roll test, also known as supine head yaw test (SHYT), which usually allows identification of the pathologic side and BPPV form (geotropic vs. apogeotropic). Nevertheless, SHYT may not always allow easy detection of the affected canal, resulting in similar responses on both sides and intense autonomic symptoms in patients with recent onset of vertigo. The newly introduced upright head roll test (UHRT) represents a diagnostic maneuver for LSC-BPPV, supplementing the already-known head pitch test (HPT) in the sitting position. The combination of these two tests should enable clinicians to determine the precise location of debris within LSC, avoiding disturbing symptoms related to supine positionings. Therefore, we proposed the upright BPPV protocol (UBP), a test battery exclusively performed in the upright position, including the evaluation of pseudo-spontaneous nystagmus (PSN), HPT and UHRT. The purpose of this multicenter study is to determine the feasibility of UBP in the diagnosis of LSC-BPPV. Methods: We retrospectively reviewed the clinical data of 134 consecutive patients diagnosed with LSC-BPPV. All of them received both UBP and the complete diagnostic protocol (CDP), including the evaluation of PSN and data resulting from HPT, UHRT, seated-supine positioning test (SSPT), and SHYT. Results: A correct diagnosis for LSC-BPPV was achieved in 95.5% of cases using exclusively the UBP, with a highly significant concordance with the CDP (p < 0.000, Cohen's kappa = 0.94), regardless of the time elapsed from symptom onset to diagnosis. The concordance between UBP and CDP was not impaired even when cases in which HPT and/or UHRT provided incomplete results were included (p < 0.000). Correct diagnosis using the supine diagnostic protocol (SDP, including SSPT + SHYT) or the sole SHYT was achieved in 85.1% of cases, with similar statistical concordance (p < 0.000) and weaker strength of relationship (Cohen's kappa = 0.80). Conclusion: UBP allows correct diagnosis in LSC-BPPV from the sitting position in most cases, sparing the patient supine positionings and related symptoms. UBP could also allow clinicians to proceed directly with repositioning maneuvers from the upright position.
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Affiliation(s)
| | - Pasquale Malara
- Audiology & Vestibology Service, Centromedico Bellinzona, Bellinzona, Switzerland
| | - Andrea Castellucci
- ENT Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Rudi Pecci
- Audiology Unit, AOU Careggi, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Beatrice Giannoni
- Audiology Unit, AOU Careggi, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | | | - Alfonso Scarpa
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Ettore Cassandro
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Silvia Quaglieri
- ENT Unit, Policlinico San Matteo Fondazione (IRCCS), Pavia, Italy
| | | | | | - Enrico Armato
- ENT Unit, SS Giovanni e Paolo Hospital, Venice, Italy
| | - Francesco Comacchio
- Department of Neurosciences, Regional Specialized Vertigo Center, Institute of Otolaryngology, University of Padua, Padua, Italy
| | - Marta Mion
- ENT Unit, Department of Surgery, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - Giuseppe Attanasio
- Head and Neck Department, ENT Clinic, Policlinico Umberto I, Rome, Italy
| | - Massimo Ralli
- Head and Neck Department, ENT Clinic, Policlinico Umberto I, Rome, Italy.,Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Antonio Greco
- Head and Neck Department, ENT Clinic, Policlinico Umberto I, Rome, Italy.,Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Marco de Vincentiis
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy.,Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Cecilia Botti
- ENT Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Luisa Savoldi
- Department Infrastructure Research and Statistics, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Califano
- Departmental Unit of Audiology and Phoniatrics, G. Rummo Hospital Group, Benevento, Italy
| | - Angelo Ghidini
- ENT Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giulio Pagliuca
- ENT Unit, Santa Maria Goretti Hospital, AUSL Latina, Latina, Italy
| | - Veronica Clemenzi
- ENT Unit, Santa Maria Goretti Hospital, AUSL Latina, Latina, Italy.,Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Andrea Stolfa
- ENT Unit, Santa Maria Goretti Hospital, AUSL Latina, Latina, Italy.,Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Andrea Gallo
- ENT Unit, Santa Maria Goretti Hospital, AUSL Latina, Latina, Italy.,Department of Sense Organs, Sapienza University of Rome, Rome, Italy
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Castellucci A, Malara P, Martellucci S, Botti C, Delmonte S, Quaglieri S, Rebecchi E, Armato E, Ralli M, Manfrin ML, Ghidini A, Asprella Libonati G. Feasibility of Using the Video-Head Impulse Test to Detect the Involved Canal in Benign Paroxysmal Positional Vertigo Presenting With Positional Downbeat Nystagmus. Front Neurol 2020; 11:578588. [PMID: 33178119 PMCID: PMC7593380 DOI: 10.3389/fneur.2020.578588] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/07/2020] [Indexed: 12/19/2022] Open
Abstract
Positional downbeat nystagmus (pDBN) represents a relatively frequent finding. Its possible peripheral origin has been widely ascertained. Nevertheless, distinguishing features of peripheral positional nystagmus, including latency, paroxysm and torsional components, may be missing, resulting in challenging differential diagnosis with central pDBN. Moreover, in case of benign paroxysmal positional vertigo (BPPV), detection of the affected canal may be challenging as involvement of the non-ampullary arm of posterior semicircular canal (PSC) results in the same oculomotor responses generated by contralateral anterior canal (ASC)-canalolithiasis. Recent acquisitions suggest that patients with persistent pDBN due to vertical canal-BPPV may exhibit impaired vestibulo-ocular reflex (VOR) for the involved canal on video-head impulse test (vHIT). Since canal hypofunction normalizes following proper canalith repositioning procedures (CRP), an incomplete canalith jam acting as a "low-pass filter" for the affected ampullary receptor has been hypothesized. This study aims to determine the sensitivity of vHIT in detecting canal involvement in patients presenting with pDBN due to vertical canal-BPPV. We retrospectively reviewed the clinical records of 59 consecutive subjects presenting with peripheral pDBN. All patients were tested with video-Frenzel examination and vHIT at presentation and after resolution of symptoms or transformation in typical BPPV-variant. BPPV involving non-ampullary tract of PSC was diagnosed in 78%, ASC-BPPV in 11.9% whereas in 6 cases the involved canal remained unidentified. Presenting VOR-gain values for the affected canal were greatly impaired in cases with persistent pDBN compared to subjects with paroxysmal/transitory nystagmus (p < 0.001). Each patient received CRP for BPPV involving the hypoactive canal or, in case of normal VOR-gain, the assumed affected canal. Each subject exhibiting VOR-gain reduction for the involved canal developed normalization of vHIT data after proper repositioning (p < 0.001), proving a close relationship with otoliths altering high-frequency cupular responses. According to our results, overall vHIT sensitivity in detecting the affected SC was 72.9%, increasing up to 88.6% when considering only cases with persistent pDBN where an incomplete canal plug is more likely to occur. vHIT should be routinely used in patients with pDBN as it may enable to localize otoconia within the labyrinth, providing further insights to the pathophysiology of peripheral pDBN.
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Affiliation(s)
- Andrea Castellucci
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Pasquale Malara
- Audiology and Vestibology Service, "Centromedico Bellinzona", Bellinzona, Switzerland
| | | | - Cecilia Botti
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy.,PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvia Delmonte
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Quaglieri
- ENT Unit, Policlinico San Matteo Fondazione (IRCCS), Pavia, Italy
| | | | - Enrico Armato
- ENT Unit, "SS Giovanni e Paolo" Hospital, Venice, Italy
| | - Massimo Ralli
- Head and Neck Department, ENT Clinic, Policlinico Umberto I, Rome, Italy.,Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | | | - Angelo Ghidini
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
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D’Elia A, Quaranta N, Asprella Libonati G, Ralli G, Morelli A, Inchingolo F, Cialdella F, Martellucci S, Barbara F. The cochleo-vestibular secretory senescence. JGG 2020. [DOI: 10.36150/2499-6564-485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Teggi R, Colombo B, Albera R, Asprella Libonati G, Balzanelli C, Batuecas Caletrio A, Casani AP, Espinosa-Sanchez JM, Gamba P, Lopez-Escamez JA, Lucisano S, Mandalà M, Neri G, Nuti D, Pecci R, Russo A, Martin-Sanz E, Sanz R, Tedeschi G, Torelli P, Vannucchi P, Comi G, Bussi M. Corrigendum: Clinical Features of Headache in Patients With Diagnosis of Definite Vestibular Migraine: The VM-Phenotypes Projects. Front Neurol 2020; 10:1374. [PMID: 32038457 PMCID: PMC6992644 DOI: 10.3389/fneur.2019.01374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 12/11/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Roberto Teggi
- ENT Department, San Raffaele Scientific Hospital, Milan, Italy
| | - Bruno Colombo
- Headache Unit, Department of Neurology, San Raffaele Scientific Hospital, Milan, Italy
| | - Roberto Albera
- Dipartimento di Scienze, Chirurgiche Università di Torino, Turin, Italy
| | - Giacinto Asprella Libonati
- U. O. S. D. "Vestibologia e Otorinolaringoiatria" Presidio Ospedaliero "Giovanni Paolo II", Policoro, Italy
| | - Cristiano Balzanelli
- Department of Otolaryngology, Spedali Civili, University of Brescia, Brescia, Italy
| | - Angel Batuecas Caletrio
- Otoneurology Unit, Department of Otorhinolaryngology, University Hospital of Salamanca, IBSAL, Salamanca, Spain.,Skull Base Unit, Department of Otorhinolaryngology, University Hospital of Salamanca, IBSAL, Salamanca, Spain
| | - Augusto P Casani
- Department of Otorhinolaryngology, Pisa University Medical School Otorhinolaryngology, Pisa University Medical School, Pisa, Italy
| | - Juan Manuel Espinosa-Sanchez
- Otology and Neurotology Group CTS495, Department of Genomic Medicine- Centro de Genómica e Investigación Oncológica - Pfizer/Universidad de Granada/Junta de Andalucía (GENYO), Granada, Spain.,Division of Otoneurology, Department of Otolaryngology, Instituto de Investigación Biosanitaria Ibs.GRANADA, Hospital Virgen de las Nieves, Granada, Spain
| | - Paolo Gamba
- Department of Otorhinolaryngology-Head and Neck Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Jose A Lopez-Escamez
- Otology and Neurotology Group CTS495, Department of Genomic Medicine- Centro de Genómica e Investigación Oncológica - Pfizer/Universidad de Granada/Junta de Andalucía (GENYO), Granada, Spain.,Division of Otoneurology, Department of Otolaryngology, Instituto de Investigación Biosanitaria Ibs.GRANADA, Hospital Virgen de las Nieves, Granada, Spain
| | - Sergio Lucisano
- Dipartimento di Scienze, Chirurgiche Università di Torino, Turin, Italy
| | - Marco Mandalà
- Otology and Skull Base Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Giampiero Neri
- Department of Neurosciences, Imaging and Clinical Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Daniele Nuti
- Otology and Skull Base Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Rudi Pecci
- Unit of Audiology, Department of Surgical Sciences and Translational Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Antonio Russo
- Department of Otolaryngology, University Hospital of Getafe, Madrid, Spain
| | - Eduardo Martin-Sanz
- Department of Neurology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Ricardo Sanz
- Department of Neurology, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Paola Torelli
- Department of Neurosciences, Headache Centre, University of Parma, Parma, Italy
| | - Paolo Vannucchi
- Unit of Audiology, Department of Surgical Sciences and Translational Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Giancarlo Comi
- Headache Unit, Department of Neurology, San Raffaele Scientific Hospital, Milan, Italy
| | - Mario Bussi
- ENT Department, San Raffaele Scientific Hospital, Milan, Italy
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Casani AP, Navari E, Albera R, Agus G, Asprella Libonati G, Chiarella G, Lombardo N, Marcelli V, Ralli G, Scotto di Santillo L, Teggi R, Viola P, Califano L. Approach to residual dizziness after successfully treated benign paroxysmal positional vertigo: effect of a polyphenol compound supplementation. Clin Pharmacol 2019; 11:117-125. [PMID: 31534374 PMCID: PMC6681902 DOI: 10.2147/cpaa.s210763] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/25/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess if a polyphenol compound supplementation (Vertigoval®) could improve residual dizziness earlier after benign paroxysmal positional vertigo (BPPV) and relieve patients from this disabling symptomatology. Methods In this prospective, multicentric study, 127 patients were randomized in the treatment group (TG), who received a 60-day supplementation, while 131 patients were randomized in the control group (CG), who did not receive any medication. The dizziness handicap inventory (DHI) score, static posturography, and the visual analog scale (VAS) for both dizziness (D-VAS) and nausea/vomit (N/V-VAS) were used as measures of outcome at baseline and after 30 and 60 days. Patients were asked about efficacy and tolerance to the treatment. Side effects were examined. Results A statistically significant greater decrease was established in the TG for DHI, D-VAS, and N/V-VAS compared to the CG. On the other hand, static posturography did not show statistical differences between the two groups, though a better clinical improvement after 60-day supplementation was shown in the TG in comparison to the CG. We counted mild side effects in only 2 patients. Most patients reported an excellent or good efficacy and tolerance to the treatment. Conclusion Residual dizziness is a frequent condition of unknown origin that manifests as persistent disabling imbalance after successful repositioning maneuvers for BPPV. The decreasing postural control can affect the quality of life, contributing to falling and psychological problems. The supplementation with the polyphenol compound used in our study is safe, manageable, and appeared to be able to reduce subjective symptoms and improve instability earlier, decreasing the risk of potential complications.
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Affiliation(s)
- Augusto Pietro Casani
- Department of Medical and Surgical Pathology, Otorhinolaryngology Section, Pisa University, Pisa, Italy
| | - Elena Navari
- Department of Medical and Surgical Pathology, Otorhinolaryngology Section, Pisa University, Pisa, Italy
| | - Roberto Albera
- Division of Otorhinolaryngology, Department of Surgical Sciences, University of Turin School of Medicine, Turin, Italy
| | - Giuseppe Agus
- Otorhinolaryngology, Private Practice, Cagliari, Italy
| | - Giacinto Asprella Libonati
- Ear, Nose and Throat Department, Unit of Audiology, Vestibology and Phoniatry, Madonna delle Grazie Hospital, Matera, Italy
| | - Giuseppe Chiarella
- Department of Experimental and Clinical Medicine, Unit of Audiology and Phoniatrics, Magna Græcia University, Catanzaro, Italy
| | - Nicola Lombardo
- Otorhinolaryngology Section, Mater Domini University, Catanzaro, Italy
| | - Vincenzo Marcelli
- Department of Neuroscience, Vestibular and Audiology Unit, University of Naples "Federico II", Naples, Italy
| | - Giovanni Ralli
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | | | - Roberto Teggi
- Ear, Nose and Throat Department, San Raffaele Scientific Hospital, Milan, Italy
| | - Pasquale Viola
- Department of Experimental and Clinical Medicine, Unit of Audiology and Phoniatrics, Magna Græcia University, Catanzaro, Italy
| | - Luigi Califano
- Audiovestibology Unit, G. Rummo Hospital, Benevento, Italy
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Quaranta N, Picciotti P, Porro G, Sterlicchio B, Danesi G, Petrone P, Asprella Libonati G. Therapeutic strategies in the treatment of Menière's disease: the Italian experience. Eur Arch Otorhinolaryngol 2019; 276:1943-1950. [PMID: 30976990 DOI: 10.1007/s00405-019-05423-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 04/07/2019] [Indexed: 01/31/2023]
Abstract
PURPOSE Ménière's disease (MD) is an inner ear disorder of unknown etiology, whose pathological substrate is the endolymphatic hydrops. Different treatments have been proposed; however, evidence of their effectiveness is lacking. The aim of this study was to evaluate by a questionnaire which medical and surgical treatments are used in Italy for the treatment of MD and to compare them with those proposed in other countries. METHODS An electronic questionnaire of 40 questions was formulated and sent to Italian otolaryngologist (ENT) divided into two groups: Group 1 ("generalists" 60.8%) and Group 2 ("neurotologist- NO" 39.2%). RESULTS One hundred and twenty five ENT replied. Treatment of the acute phase, apart from symptomatics, was based on diuretics that are prescribed by 83.5% of respondents, steroids, prescribed by 66.7%, and vasodilators, prescribed by 22%. In the intercritical phase, 87.2% of respondents recommended low-salt diet, 78.4% of respondents prescribed betahistine, and 52.8% diuretics. Statistical analysis did not show correlation neither with the declared specialization nor with the number of patients treated. In case of failure of medical treatment, IT gentamicin was suggested by 48.8% of the respondents and IT steroids by 40.8%. Statistical analysis showed that generalists prefer IT steroids and NO IT gentamicin (p 0.019). In case of failure of both medical treatment and IT treatment, vestibular neurectomy was indicated by 58.4% of the respondents, 6.4% indicated endolymphatic sac surgery, and 2.4% surgical labyrinthectomy. CONCLUSION In Italy, the treatment of MD stand on a gradual approach that starts from the dietary-behavioral changes and a pharmacological therapy based on betahistine. In refractory cases, IT treatment initially with steroids and, therefore, with gentamicin allows the control in vertigo in the majority of cases. In case of failure of IT treatment, VNS is the surgery of choice.
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Affiliation(s)
- Nicola Quaranta
- Otolaryngology Unit, Department of BMS, Neuroscience and Sensory Organs, University of Bari, Bari, Italy.
| | - P Picciotti
- Department of Head and Neck Surgery, Otorhinolaryngology, Catholic University of Sacred Heart, Rome, Italy
| | - G Porro
- Otolaryngology Unit, Department of BMS, Neuroscience and Sensory Organs, University of Bari, Bari, Italy
| | - B Sterlicchio
- Otolaryngology Unit, Department of BMS, Neuroscience and Sensory Organs, University of Bari, Bari, Italy
| | - G Danesi
- Division of Ear, Nose, and Throat, and Skull Base Microsurgery, Ospedali Riuniti, Bergamo, Italy
| | - P Petrone
- UOSD Otolaryngology, Ospedale San Giacomo, Monopoli, Bari, Italy
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11
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Teggi R, Colombo B, Albera R, Asprella Libonati G, Balzanelli C, Batuecas Caletrio A, Casani AP, Espinosa-Sanchez JM, Gamba P, Lopez-Escamez JA, Lucisano S, Mandalà M, Neri G, Nuti D, Pecci R, Russo A, Martin-Sanz E, Sanz R, Tedeschi G, Torelli P, Vannucchi P, Comi G, Bussi M. Clinical Features of Headache in Patients With Diagnosis of Definite Vestibular Migraine: The VM-Phenotypes Projects. Front Neurol 2018; 9:395. [PMID: 29922214 PMCID: PMC5996089 DOI: 10.3389/fneur.2018.00395] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 05/14/2018] [Indexed: 01/03/2023] Open
Abstract
Migraine is a common neurological disorder characterized by episodic headaches with specific features, presenting familial aggregation. Migraine is associated with episodic vertigo, named Vestibular Migraine (VM) whose diagnosis mainly rely on clinical history showing a temporary association of symptoms. Some patient refers symptoms occurring in pediatric age, defined "episodic symptoms which may be associated with migraine." The aim of this cross sectional observational study was to assess migraine-related clinical features in VM subjects. For the purpose, 279 patients were recruited in different centers in Europe; data were collected by a senior neurologist or ENT specialist through a structured questionnaire. The age of onset of migraine was 21.8 ± 9. The duration of headaches was lower than 24 h in 79.1% of cases. Symptoms accompanying migrainous headaches were, in order of frequency, nausea (79.9%), phonophobia (54.5%), photophobia (53.8%), vomiting (29%), lightheadedness (21.1%). Visual or other auras were reported by 25.4% of subjects. A familial aggregation was referred by 67.4%, while migraine precursors were reported by 52.3% of subjects. Patients reporting nausea and vomiting during headaches more frequently experienced the same symptoms during vertigo. Comparing our results in VM subjects with previously published papers in migraine sufferers, our patients presented a lower duration of headaches and a higher rate of familial aggregation; moreover some common characters were observed in headache and vertigo attacks for accompanying symptoms like nausea and vomiting and clustering of attacks.
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Affiliation(s)
- Roberto Teggi
- ENT Department, San Raffaele Scientific Hospital, Milan, Italy
| | - Bruno Colombo
- Headache Unit, Department of Neurology, San Raffaele Scientific Hospital, Milan, Italy
| | - Roberto Albera
- Dipartimento di Scienze, Chirurgiche Università di Torino, Turin, Italy
| | - Giacinto Asprella Libonati
- U. O. S. D. "Vestibologia e Otorinolaringoiatria" Presidio Ospedaliero "Giovanni Paolo II", Policoro, Italy
| | - Cristiano Balzanelli
- Department of Otolaryngology, Spedali Civili, University of Brescia, Brescia, Italy
| | - Angel Batuecas Caletrio
- Otoneurology Unit, Department of Otorhinolaryngology, University Hospital of Salamanca, IBSAL, Salamanca, Spain.,Skull Base Unit, Department of Otorhinolaryngology, University Hospital of Salamanca, IBSAL, Salamanca, Spain
| | - Augusto P Casani
- Department of Otorhinolaryngology, Pisa University Medical School Otorhinolaryngology, Pisa University Medical School, Pisa, Italy
| | - Juan Manuel Espinosa-Sanchez
- Otology and Neurotology Group CTS495, Department of Genomic Medicine- Centro de Genómica e Investigación Oncológica - Pfizer/Universidad de Granada/Junta de Andalucía (GENYO), Granada, Spain.,Division of Otoneurology, Department of Otolaryngology, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospital Virgen de las Nieves, Granada, Spain
| | - Paolo Gamba
- Department of Otorhinolaryngology-Head and Neck Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Jose A Lopez-Escamez
- Otology and Neurotology Group CTS495, Department of Genomic Medicine- Centro de Genómica e Investigación Oncológica - Pfizer/Universidad de Granada/Junta de Andalucía (GENYO), Granada, Spain.,Division of Otoneurology, Department of Otolaryngology, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospital Virgen de las Nieves, Granada, Spain
| | - Sergio Lucisano
- Dipartimento di Scienze, Chirurgiche Università di Torino, Turin, Italy
| | - Marco Mandalà
- Otology and Skull Base Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Giampiero Neri
- Department of Neurosciences, Imaging and Clinical Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Daniele Nuti
- Otology and Skull Base Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Rudi Pecci
- Unit of Audiology, Department of Surgical Sciences and Translational Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Antonio Russo
- Department of Otolaryngology, University Hospital of Getafe, Madrid, Spain
| | - Eduardo Martin-Sanz
- Department of Neurology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Ricardo Sanz
- Department of Neurology, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Paola Torelli
- Department of Neurosciences, Headache Centre, University of Parma, Parma, Italy
| | - Paolo Vannucchi
- Unit of Audiology, Department of Surgical Sciences and Translational Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Giancarlo Comi
- Headache Unit, Department of Neurology, San Raffaele Scientific Hospital, Milan, Italy
| | - Mario Bussi
- ENT Department, San Raffaele Scientific Hospital, Milan, Italy
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12
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Teggi R, Colombo B, Albera R, Asprella Libonati G, Balzanelli C, Batuecas Caletrio A, Casani A, Espinoza-Sanchez JM, Gamba P, Lopez-Escamez JA, Lucisano S, Mandalà M, Neri G, Nuti D, Pecci R, Russo A, Martin-Sanz E, Sanz R, Tedeschi G, Torelli P, Vannucchi P, Comi G, Bussi M. Clinical Features, Familial History, and Migraine Precursors in Patients With Definite Vestibular Migraine: The VM-Phenotypes Projects. Headache 2017; 58:534-544. [DOI: 10.1111/head.13240] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 11/18/2017] [Accepted: 11/18/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Roberto Teggi
- ENT Department; San Raffaele Scientific Hospital; Milan Italy
| | - Bruno Colombo
- Headache Unit, Department of Neurology; San Raffaele Scientific Hospital; Milan Italy
| | - Roberto Albera
- Dipartimento di Scienze; Chirurgiche Università di Torino; Turin Italy
| | - Giacinto Asprella Libonati
- U.O.S.D. “Vestibologia e Otorinolaringoiatria” Presidio Ospedaliero “Giovanni Paolo II,”; Policoro MT Italy
| | - Cristiano Balzanelli
- Department of Otolaryngology, Spedali Civili; University of Brescia; Brescia Italy
| | - Angel Batuecas Caletrio
- Otoneurology Unit, Department of Otorhinolaryngology, University Hospital of Salamanca, IBSAL, Salamanca, Spain; Skull Base Unit, Department of Otorhinolaryngology; University Hospital of Salamanca, IBSAL; Salamanca Spain
| | - Augusto Casani
- Department of Otorhinolaryngology-Pisa University Medical School Otorhinolaryngology; Pisa University Medical School; Pisa Italy
| | - Juan Manuel Espinoza-Sanchez
- Otology and Neurotology Group, Department of Genomic Medicine, Centre for Genomics and Oncological Research (GENYO); Pfizer-University of Granada-Junta de Andalucia; Granada Spain
- Department of Otolaryngology; Hospital San Agustin; Linares Jaen Spain
| | - Paolo Gamba
- Department of Otorhinolaryngology-Head and Neck Surgery; Poliambulanza Foundation Hospital; Brescia Italy
| | - Jose A. Lopez-Escamez
- Otology & Neurotology Group CTS495, Department of Genomic Medicine, GENYO-Centre for Genomics and Oncological Research; Pfizer/University of Granada/Junta de Andalucia, PTS; Granada Spain
- Division of Otoneurology; Department of Otolaryngology, Hospital Universitario Virgen de las Nieves; Granada Spain
| | - Sergio Lucisano
- Dipartimento di Scienze; Chirurgiche Università di Torino; Turin Italy
| | - Marco Mandalà
- Otology and Skull Base Unit; Azienda Ospedaliera Universitaria Senese; Siena Italy
| | - Giampiero Neri
- Department of Neurosciences, Imaging and Clinical Sciences; University of Chieti-Pescara; Chieti Italy
| | - Daniele Nuti
- Otology and Skull Base Unit; Azienda Ospedaliera Universitaria Senese; Siena Italy
| | - Rudy Pecci
- Unit of Audiology, Department of Surgical Sciences and Translational Medicine, Careggi Hospital; University of Florence; Florence Italy
| | - Antonio Russo
- University of Campania Luigi Vanvitelli; Naples Italy
| | | | - Ricardo Sanz
- Department of Otolaryngology; University Hospital of Getafe; Madrid Spain
| | | | - Paola Torelli
- Department of Neurosciences, Headache Centre; University of Parma; Parma Italy
| | - Paolo Vannucchi
- Unit of Audiology, Department of Surgical Sciences and Translational Medicine, Careggi Hospital; University of Florence; Florence Italy
| | - Giancarlo Comi
- Headache Unit, Department of Neurology; San Raffaele Scientific Hospital; Milan Italy
| | - Mario Bussi
- ENT Department; San Raffaele Scientific Hospital; Milan Italy
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13
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Mandalà M, Santoro GP, Asprella Libonati G, Casani AP, Faralli M, Giannoni B, Gufoni M, Marcelli V, Marchetti P, Pepponi E, Vannucchi P, Nuti D. Double-blind randomized trial on short-term efficacy of the Semont maneuver for the treatment of posterior canal benign paroxysmal positional vertigo. J Neurol 2011; 259:882-5. [DOI: 10.1007/s00415-011-6272-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Accepted: 09/29/2011] [Indexed: 11/30/2022]
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Gallo O, Libonati GA, Gallina E, Fini-Storchi O, Giannini A, Urso C, Bondi R. Langerhans cells related to prognosis in patients with laryngeal carcinoma. Arch Otolaryngol Head Neck Surg 1991; 117:1007-10. [PMID: 1910715 DOI: 10.1001/archotol.1991.01870210079015] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Intratumoral and peritumoral infiltration of T-zone histiocytes, mainly of mature Langerhans cells, was investigated in 88 patients with squamous cell carcinoma of the larynx by immunohistochemical methods using polyclonal antibodies against S100 protein and lysozyme. Granulocytic and lymphoid inflammatory infiltration and its relationship to the presence of Langerhans cells were also evaluated. Langerhans cells were present within the cancer tissues and showed a relationship with lymphoid infiltrate. No significant correlation was present among the density of Langerhans cells and the site of neoplastic growth (supraglottic or subglottic), granulocytic inflammatory infiltration, histological tumor grade, or clinical stage. Patients with high or intermediate density of Langerhans cells survived longer than those with low density (mean survival, 61%, 62%, and 0%, respectively). The number of Langerhans cells was relevant in patients with evident infiltration of lymphocytes and plasma cells, according to their ability to present antigens to sensitized T cells. Our results indicate that the presence of high or intermediate density of Langerhans cells and of marked lymphoid inflammation may be considered favorable prognostic factors for patients with squamous cell carcinoma of the larynx.
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Affiliation(s)
- O Gallo
- Otorhinolaryngological Clinic II, University of Florence, Italy
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Gallo O, Bianchi S, Giannini A, Gallina E, Libonati GA, Fini-Storchi O. Correlations between histopathological and biological findings in nasopharyngeal carcinoma and its prognostic significance. Laryngoscope 1991; 101:487-93. [PMID: 2030628 DOI: 10.1288/00005537-199105000-00008] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Forty-five consecutive cases of nasopharyngeal carcinoma were morphologically and immunocytochemically studied using monoclonal (anti-B and anti-T cell) and polyclonal (anti-S100 protein and antilysozyme) antibodies with the peroxidase-anti-peroxidase method to identify infiltrating lymphocytes (T and B cell) and histiocytes (monocytic/macrophagic and dendritic cells) in nasopharyngeal carcinoma. A variable density of dendritic cells was found within the tumor nests in 22 (49%) of 45 nasopharyngeal carcinomas examined; infiltrating macrophages were demonstrated in 15 (33%) specimens and around the tumor in almost all cases. Cases with moderate or marked density of dendritic cells (S100+) survived longer than those without such infiltration (mean 5-year survival rates of 31%, 55%, or 64% in patients with absent, moderate, or marked densities, respectively; P less than 0.05). A significant relationship between monocytic/macrophagic cells (lysozyme+) within the tumor and survival was also found (mean 5-year survival rate of 27% or 61% in patients with absent, moderate, or marked densities, respectively). However, lymphocytic infiltration was not statistically related to a better survival. Analyzing lymphocytic infiltration, we found a large prevalence of T cells in the neoplastic tissue without any prognostic significance. These data were correlated to different histological subtypes according to the principal histological classifications of nasopharyngeal carcinomas (Micheau, et al.; World Health Organization; Cologne University) to individualize the scheme which correlates best with prognosis and biological features of nasopharyngeal carcinomas. Our data suggest that, considering dendritic cells and macrophages within cancer nests, nasopharyngeal carcinoma histiotypes can be correlated to patient prognosis.
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Affiliation(s)
- O Gallo
- Second Clinic of Otorhinolaryngology, University of Florence, Italy
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Fini-Storchi O, Lo Russo D, Agostini V, Libonati GA, Pastorelli E. [Surgical treatment in 155 cases of hypopharyngeal carcinoma: analysis of results and causes of failure]. Acta Otorhinolaryngol Ital 1990; 10:337-46. [PMID: 1966400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A retrospective study has been performed on 155 cases of surgically treated hypopharyngeal carcinomas in order to bring to light what effect the type of surgery has on survival and the reasons for failure. The following operations were performed: 103 hemipharyngectomies with total laryngectomy (HPTL); 28 total circular pharyngectomies with total laryngectomy (CPTL); 16 hemipharyngectomies with partial laryngectomy (HPPL); 4 exereses in lateral pharyngectomy; 2 total laryngectomies and 2 hemipharyngectomies in lateral pharyngotomy. Analysis of the results is only performed on the three most numerous groups of patients. The overall neoplastic mortality rate at 5 years was 79% for the HPTL group while it was 50% and 61% in the CPTL and HPPL groups, respectively. The actuarial survival curves show a higher, statistically significant, cumulative 5-year survival rate for the CPTL group (55.9%) than for the HPTL group (30.5%). The authors conclude that, considering the particular submucosa spreading to which hypopharyngeal carcinoma is subject and the good functional recovery which can be obtained with modern reconstructive surgery of the alimentary tract, CPTL should be the treatment of choice, even in the less advanced cases, in order to significantly reduce the risk of local recurrences.
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