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De Corso E, Baroni S, Settimi S, Onori ME, di Cesare T, Mastrapasqua RF, Sarlo F, Penazzi D, D'Agostino G, D'Auria LM, De Maio G, Fetoni AR, Galli J. Correlation between inflammatory biomarkers and disease control in chronic rhinosinusitis with nasal polyps. Int Forum Allergy Rhinol 2024. [PMID: 38266634 DOI: 10.1002/alr.23319] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 11/28/2023] [Accepted: 12/28/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) may have a heterogeneous response to medical/surgical treatments based on endotypes. Data correlating biomarkers and severity of the disease are lacking. We aimed to determine if IL-5 and calprotectin may be useful in defining severity of disease and identifying uncontrolled patients. METHODS This was a case-control study including 81 patients with diffuse CRSwNP who underwent at least one previous surgery and treated with intranasal steroids. We enrolled 39 uncontrolled patients (SNOT-22 ≥ 40 and two or more cycles of systemic corticosteroids in last year) (Group A) and 42 controlled one (SNOT-22 < 40 and less than two cycles of systemic corticosteroids in last year) (Group B). We analyzed IL-5 and calprotectin in both nasal secretions and nasal polyp tissue. RESULTS Calprotectin and IL-5 were significantly higher in Group A in both secretions and tissue, and the higher the number of previous surgeries, the higher the levels detected in nasal secretions. At univariate analyses, smoking, asthma, non-steroidal anti-inflammatory drugs-exacerbated respiratory disease (NSAID-ERD), blood eosinophilia, neutrophils, and eosinophils at nasal cytology were significantly associated with uncontrolled disease. Multivariate analyses showed that asthma, NSAID-ERD, and IL-5 in nasal secretion/polyp tissue were significantly related to the risk of uncontrolled disease. CONCLUSIONS Our data suggest that asthma, NSAID-ERD, and IL-5 in nasal secretions/tissue may be helpful to identify more severe patients, as they are related to the risk of uncontrolled disease. Nonetheless, high levels of calprotectin and neutrophilia were also observed in uncontrolled patients, especially after multiple surgeries.
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Affiliation(s)
- Eugenio De Corso
- Unit of Otorhinolaryngology and Head-Neck Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Silvia Baroni
- Unit of Chemistry, Biochemistry and Molecular Biology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Settimi
- Unit of Otorhinolaryngology and Head-Neck Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Elisabetta Onori
- Molecular and Genomic Diagnostics Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Tiziana di Cesare
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Francesca Sarlo
- Unit of Chemistry, Biochemistry and Molecular Biology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Daniele Penazzi
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe D'Agostino
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Leandro Maria D'Auria
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gabriele De Maio
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Rita Fetoni
- Department of Neuroscience, Reproductive Sciences and Dentistry-Audiology Section, Università degli studi di Napoli Federico II, Naples, Italy
| | - Jacopo Galli
- Unit of Otorhinolaryngology and Head-Neck Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy
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Marchese MR, Rossi F, Settimi S, Galli J. Late Prevalence of Typical and Atypical Symptoms of Frey's Syndrome after Parotidectomy for Benign Tumor. J Pers Med 2024; 14:96. [PMID: 38248797 PMCID: PMC10820002 DOI: 10.3390/jpm14010096] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/07/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND The treatment of choice for tumors located in the parotid gland is surgery. Nevertheless, postoperative complications are not infrequent. Regardless of the type of surgical procedure, the most common complication is Frey's syndrome (FS). Traditionally, FS includes unilateral gustatory sweating and flushing of the facial skin lining the parotid compartment. Recent research describes atypical discomfort associated with FS. The aim of this study was to assess the late prevalence and severity of both usual and atypical symptoms after parotidectomy for benign tumors. METHODS We conducted a cross-sectional study involving 86 subjects who underwent superficial parotidectomy at least one year before the study. The questionnaire included the sweating-flushing-itch-paresthesia-pain (SFIPP) Frey scale supplemented by specific questions about symptoms. RESULTS Sixty-seven out of eighty-six (77.9%) cases reported almost one symptom. The most frequent symptom was itch (36/67-53.7%), followed by pain (35/67-52.2%), while 28/67 (41.8%) subjects complained of atypical symptoms without flushing or sweating. A desire to treat the discomfort was reported by 50/67 (74.6%) subjects. CONCLUSIONS Late postparotidectomy local discomfort is not infrequent and includes both usual and "unusual" symptoms almost equally. Our results suggest the importance of informing patients about the occurrence of the syndrome and the available treatment options during pre- and postoperative counseling.
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Affiliation(s)
- Maria Raffaella Marchese
- Otolaryngology Division, Department of Neurosciences, Sensory Organs and Thorax, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (M.R.M.); (J.G.)
| | - Federica Rossi
- Section of Otolaryngology, Head-Neck and Sense Organs Department, Catholic University of the Sacred Heart, 00168 Rome, Italy;
| | - Stefano Settimi
- Otolaryngology Division, Department of Neurosciences, Sensory Organs and Thorax, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (M.R.M.); (J.G.)
- Section of Otolaryngology, Head-Neck and Sense Organs Department, Catholic University of the Sacred Heart, 00168 Rome, Italy;
| | - Jacopo Galli
- Otolaryngology Division, Department of Neurosciences, Sensory Organs and Thorax, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (M.R.M.); (J.G.)
- Section of Otolaryngology, Head-Neck and Sense Organs Department, Catholic University of the Sacred Heart, 00168 Rome, Italy;
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Picciotti PM, Rossi G, Settimi S, Fetoni AR, Coppola M, Galli J. Validity of Italian adaptation of the Vanderbilt Paediatric Dizziness Handicap Inventory. Acta Otorhinolaryngol Ital 2023; 43:341-347. [PMID: 37519142 PMCID: PMC10551725 DOI: 10.14639/0392-100x-n2552] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/23/2023] [Indexed: 08/01/2023]
Abstract
Objective The paediatric caregiver version of the Dizziness Handicap Inventory (DHI-PC) questionnaire is a useful Quality of Life (QoL) evaluation instrument for children experiencing dizziness, vertigo or unsteadiness. Its English version has been validated for use with a paediatric population between 5 and 12 years of age. The aim of this work is to validate the DHI-PC into Italian for both patient assessment and appropriate rehabilitative treatment planning. Materials and methods Cross-cultural adaptation of the DHI-PC was performed using standard techniques. Items of the original questionnaire were translated into Italian by two bilingual investigators. Two native English speakers carried out a back translation of the new version that was compared with the original to check that they had the same semantic value. A pre-final version was obtained by an expert committee and was applied in a pilot test. Results A total of 42 patient caregivers completed the final adapted questionnaire twice with an interval of 2 weeks. Internal consistency was excellent, with Cronbach's alpha = 0.95. Conclusions Our study showed evidence that the Italian version of DHI-PC is a valid and reliable tool to quantify the degree of dizziness handicap and its application is recommended.
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Affiliation(s)
- Pasqualina Maria Picciotti
- Unit of Otorhinolaryngology - Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, Rome, Italy
| | - Giorgia Rossi
- Unit of Otorhinolaryngology - Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stefano Settimi
- Unit of Otorhinolaryngology - Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, Rome, Italy
| | - Anna Rita Fetoni
- Department of Neuroscience, Reproductive sciences and Dentistry - Audiology Section, University of Naples Federico II, Naples, Italy
| | - Maria Coppola
- Neonatal Intensive Care Unit, sub TIN, Neonatal Pathology and Neonatology, San Giovanni Calibita Fatebenefratelli Hospital - Gemelli Isola, Rome, Italy
| | - Jacopo Galli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, Rome, Italy
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De Corso E, Pipolo C, Cantone E, Ottaviano G, Gallo S, Trimarchi M, Torretta S, Cavaliere C, Lucidi D, Seccia V, Settimi S, Canevari FRM, Pasquini E, La Mantia I, Garzaro M, Bellocchi G, De Benedetto M, Lombardo N, Macchi A, Malvezzi L, Motta G, Vicini C, Maselli A, Dell’Era V, Dragonetti A, Asprea F, Lupato V, Ghidini A, Masieri S, Mattavelli D, Salzano FA, Passali D, Galli J, Pagella F. Practical recommendations for managing severe chronic rhinosinusitis with nasal polyps in the era of biologics. Acta Otorhinolaryngol Ital 2023; 43:324-340. [PMID: 37224173 PMCID: PMC10551726 DOI: 10.14639/0392-100x-n2422] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/09/2023] [Indexed: 05/26/2023]
Abstract
Objective We conducted a national survey to understand how rhinology practice has changed with the advent of biologics and how this affected patients with uncontrolled, severe chronic rhinosinusitis with nasal polyps (CRSwNP). We aimed to analyse the results of the survey and infer practical recommendations for clinical practice. Methods A group of ear, nose, and throat specialists (ENTs) experienced in the management of CRSwNP developed a 74-question survey. ENTs from rhinology centres authorised to prescribe biologics in the context of the national health system were invited to answer it between 01/05/2022 and 31/07/2022. The responses underwent descriptive analyses, and the authors discussed the results and derived practical recommendations for clinical practice. Results ENTs working in rhinology centres changed their practices coinciding with the advent of biologics. CRSwNP evaluations have become more complex because they involve diagnostic confirmation, determining the patients' immunologic profile, and other factors. We observed heterogenous behaviours in practice that may be conditioned by the novelty of the topic. The results of the survey were used to develop practical recommendations for ENTs and are summarised herein. Conclusions Clinical practice in rhinology outpatient clinics has changed profoundly in the era of biologics. Our practical recommendations for clinicians working in rhinology centres are expected to help standardise practice and improve care.
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Affiliation(s)
- Eugenio De Corso
- Otorhinolaryngology Unit, Head and Neck Department, A. Gemelli Universitary Hospital Foundation IRCCS, Rome, Italy
| | - Carlotta Pipolo
- Otorhinolaryngology Unit, Head and Neck Department, Dipartimento di Scienze della Salute, Università degli Studi di Milano, ASST Santi Paolo e Carlo Hospital, Milan, Italy
| | - Elena Cantone
- Department of Neurosciences, Reproductive and Odontostomatologic Sciences, Unit of Ear, Nose and Throat, “Federico II” University, Naples, Italy
| | - Giancarlo Ottaviano
- Department of Neuroscience DNS, Otolaryngology Section, University of Padua, Padua, Italy
| | - Stefania Gallo
- Otorhinolaryngology Unit, Head and Neck Department, ASST Sette Laghi and UPLOAD Research Center, University of Insubria, Varese, Italy
| | - Matteo Trimarchi
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Torretta
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Cavaliere
- Dipartimento di scienze odontostomatologiche e maxillo facciali. Sapienza University of Rome, Rome, Italy
| | - Daniela Lucidi
- Department of Otolaryngology – Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Veronica Seccia
- Otolaryngology, Audiology, and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology, and Critical Care Medicine, Pisa University Hospital, Pisa, Italy
| | | | - Frank Rikki Mauritz Canevari
- UOC di Otorinolaringoiatria IRCCS Policlinico San Martino Genova, Dipartimento DISC Università di Genova, Genoa, Italy
| | - Ernesto Pasquini
- ENT Unit “Bellaria” Hospital – Specialized Dep AUSL Bologna, Italy
| | | | | | | | | | - Nicola Lombardo
- ENT Unit Department of Medical and Surgical Sciences, University Magna Græcia Catanzaro, Italy
| | - Alberto Macchi
- ENT University of Insubria, ASST Settelaghi, Varese, Italy
| | - Luca Malvezzi
- IRCCS Humanitas Research Hospital, Department of Otorhinolaryngology and Head and Neck Surgery, Rozzano (MI), Italy
| | - Gaetano Motta
- Otorhinolaryngology – Head and Neck Surgery, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Alessandro Maselli
- Department Otorhinolaryngology, Hospital of Barletta, Barletta (BT), Italy
| | - Valeria Dell’Era
- ENT Division, Maggiore Hospital, Eastern Piedmont University – Novara, Italy
| | | | - Francesco Asprea
- Otorinolaringoiatria e audiologia. Università degli studi di Messina, Messina, Italy
| | - Valentina Lupato
- Division of Otolaryngology, Ospedale Civile di Pordenone, Azienda Sanitaria Friuli Occidentale (ASFO), Pordenone, Italy
| | - Angelo Ghidini
- Otorinolaringoiatria Azienda USL di Reggio Emilia/IRCCS, Italy
| | - Simonetta Masieri
- Dipartimento di scienze odontostomatologiche e maxillo facciali. Sapienza University of Rome, Rome, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology – Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, ASST Spedali Civili di Brescia – University of Brescia, Brescia, Italy
| | | | | | - Jacopo Galli
- Otorhinolaryngology Unit, Head and Neck Department, A. Gemelli Universitary Hospital Foundation IRCCS, Rome, Italy
- Catholic University of The Sacred Heart, Rome, Italy
| | - Fabio Pagella
- Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy
- Otorhinolaryngology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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De Corso E, Pasquini E, Trimarchi M, La Mantia I, Pagella F, Ottaviano G, Garzaro M, Pipolo C, Torretta S, Seccia V, Cantone E, Ciofalo A, Lucidi D, Fadda GL, Pafundi PC, Settimi S, Montuori C, Anastasi F, Pagliuca G, Ghidini A, Cavaliere C, Maffei M, Bussu F, Gallo S, Canevari FRM, Paludetti G, Galli J. Dupilumab in the treatment of severe uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP): A multicentric observational Phase IV real-life study (DUPIREAL). Allergy 2023; 78:2669-2683. [PMID: 37203259 DOI: 10.1111/all.15772] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [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: 01/30/2023] [Revised: 04/08/2023] [Accepted: 05/01/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) is associated with significant morbidity and reduced health-related quality of life. Findings from clinical trials have demonstrated the effectiveness of dupilumab in CRSwNP, although real-world evidence is still limited. METHODS This Phase IV real-life, observational, multicenter study assessed the effectiveness and safety of dupilumab in patients with severe uncontrolled CRSwNP (n = 648) over the first year of treatment. We collected data at baseline and after 1, 3, 6, 9, and 12 months of follow-up. We focused on nasal polyps score (NPS), symptoms, and olfactory function. We stratified outcomes by comorbidities, previous surgery, and adherence to intranasal corticosteroids, and examined the success rates based on current guidelines, as well as potential predictors of response at each timepoint. RESULTS We observed a significant decrease in NPS from a median value of 6 (IQR 5-6) at baseline to 1.0 (IQR 0.0-2.0) at 12 months (p < .001), and a significant decrease in Sino-Nasal Outcomes Test-22 (SNOT-22) from a median score of 58 (IQR 49-70) at baseline to 11 (IQR 6-21; p < .001) at 12 months. Sniffin' Sticks scores showed a significant increase over 12 months (p < .001) compared to baseline. The results were unaffected by concomitant diseases, number of previous surgeries, and adherence to topical steroids, except for minor differences in rapidity of action. An excellent-moderate response was observed in 96.9% of patients at 12 months based on EPOS 2020 criteria. CONCLUSIONS Our findings from this large-scale real-life study support the effectiveness of dupilumab as an add-on therapy in patients with severe uncontrolled CRSwNP in reducing polyp size and improving the quality of life, severity of symptoms, nasal congestion, and smell.
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Affiliation(s)
- Eugenio De Corso
- Otorhinolaryngology Unit, A.Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Ernesto Pasquini
- Otorhinolaryngology Unit, Ospedale Bellaria Dip Chirurgie Specialistiche AUSL, Bologna, Italy
| | - Matteo Trimarchi
- Otorhinolaryngology Unit, Head and Neck Department, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Ignazio La Mantia
- Department of Medical-Surgical Sciences and Advanced Technologies, E.N.T. Unit, P.O. "G. Rodolico", University of Catania, Catania, Italy
| | - Fabio Pagella
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Giancarlo Ottaviano
- Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy
| | - Massimiliano Garzaro
- Department of Otorhinolaryngology, Rhinology Unit, Eastern Piedmont University, Maggiore Hospital, Novara, Italy
| | - Carlotta Pipolo
- Otorhinolaryngology Unit, Department of Health Sciences, ASST Santi Paolo e Carlo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Sara Torretta
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico", University of Milan, Milan, Italy
| | - Veronica Seccia
- Otolaryngology, Audiology and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Elena Cantone
- Department of Neuroscience, Reproductive and Odontostomatological Sciences-ENT Section, Head and Neck Department-ENT Section, University of Naples Federico II, AOU Federico II, Naples, Italy
| | - Andrea Ciofalo
- Rhinology Unit, Department of Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Daniela Lucidi
- Department of Otolaryngology-Head and Neck Surgery, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Gian Luca Fadda
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Pia Clara Pafundi
- Epidemiology and Biostatistics Core Facility, Gemelli Science and Technology park, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Stefano Settimi
- Department of Head, Neck and Sensory Organs, Catholic University of The Sacred Heart, Rome, Italy
| | - Claudio Montuori
- Department of Head, Neck and Sensory Organs, Catholic University of The Sacred Heart, Rome, Italy
| | - Francesca Anastasi
- Otorhinolaryngology Unit, Ospedale San Giovanni Evangelista, Tivoli, Italy
| | - Giulio Pagliuca
- Otolaryngology University Unit, "S. M. Goretti Hospital", Latina, Italy
| | - Angelo Ghidini
- ENT Department, Azienda USL Reggio Emilia-IRCCS, Reggio Emilia, Italy
| | - Carlo Cavaliere
- Department of Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Marianna Maffei
- Otolaryngology Head and Neck Surgery Unit, AORN Ospedali della Colli, Naples, Italy
| | - Francesco Bussu
- Division of Otorhinolaryngology, Department of Medicine, Surgery and Pharmacy, Azienda Ospedaliera Universitaria di Sassari, University of Sassary, Sassari, Italy
| | - Stefania Gallo
- Otorinolaryngology Unit, Head and Neck Department, ASST Sette Laghi and UPLOAD Research Center, University of Insubria, Varese, Italy
| | | | - Gaetano Paludetti
- Department of Head, Neck and Sensory Organs, Catholic University of The Sacred Heart, Rome, Italy
| | - Jacopo Galli
- Department of Head, Neck and Sensory Organs, Catholic University of The Sacred Heart, Rome, Italy
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De Corso E, Settimi S, Montuori C, Cantiani A, Corbò M, Di Bella GA, Sovardi F, Pagella F, Rigante M, Passali GC, Paludetti G, Galli J. How to manage recurrences after surgery in CRSwNP patients in the biologic era: a narrative review. Acta Otorhinolaryngol Ital 2023; 43:S3-S13. [PMID: 37698095 PMCID: PMC10159635 DOI: 10.14639/0392-100x-suppl.1-43-2023-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 09/13/2023]
Abstract
Objective This narrative review analyses factors affecting recurrence of Chronic rhinosinusitis with nasal polyps (CRSwNP) after surgery, such as type, extension and completeness of endoscopic sinus surgery (ESS). We also described new implications in the management of recurrences after the advent of biologics. Methods We identified four topics: definition of disease state; factors linked to recurrence of polyps; evaluation and management of recurrence in clinical practice. Results We analysed the differences between exacerbation and recurrence, as well as the concept of "controlled disease". We focused on potential predictors of recurrence after ESS, such as type 2 inflammation, asthma, aspirin-exacerbated respiratory disease, incomplete initial surgery and lack of adherence to long-term post-operative local corticosteroids. We discussed the new aspects of diagnosis and treatment of recurrences after surgery, summarising our suggestions in a detailed algorithm for practical management of patients with recurrent disease. Conclusions The results emphasised the importance of accurate evaluation of patients with CRSwNP recurrence, focusing on the reasons of failure and risk of disease progression, in order to guide personalised interventions. It is crucial to define the concept of appropriate surgery, which affects the choice between starting a biologic or repeating surgery.
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Affiliation(s)
- Eugenio De Corso
- Unit of Otorhinolaryngology, “A. Gemelli” University Hospital Foundation IRCCS, Rome, Italy
| | - Stefano Settimi
- Unit of Otorhinolaryngology, “A. Gemelli” University Hospital Foundation IRCCS, Rome, Italy
- Department of Head, Neck and Sensory Organs, Catholic University of Sacred Heart, Rome, Italy
| | - Claudio Montuori
- Department of Head, Neck and Sensory Organs, Catholic University of Sacred Heart, Rome, Italy
| | - Alessandro Cantiani
- Department of Head, Neck and Sensory Organs, Catholic University of Sacred Heart, Rome, Italy
| | - Marco Corbò
- Department of Head, Neck and Sensory Organs, Catholic University of Sacred Heart, Rome, Italy
| | | | - Fabio Sovardi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Fabio Pagella
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Mario Rigante
- Unit of Otorhinolaryngology, “A. Gemelli” University Hospital Foundation IRCCS, Rome, Italy
| | - Giulio Cesare Passali
- Unit of Otorhinolaryngology, “A. Gemelli” University Hospital Foundation IRCCS, Rome, Italy
- Department of Head, Neck and Sensory Organs, Catholic University of Sacred Heart, Rome, Italy
| | - Gaetano Paludetti
- Unit of Otorhinolaryngology, “A. Gemelli” University Hospital Foundation IRCCS, Rome, Italy
| | - Jacopo Galli
- Unit of Otorhinolaryngology, “A. Gemelli” University Hospital Foundation IRCCS, Rome, Italy
- Department of Head, Neck and Sensory Organs, Catholic University of Sacred Heart, Rome, Italy
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7
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Pirola F, Giombi F, Ferreli F, Costantino A, Mercante G, Paoletti G, Heffler E, Canonica GW, Settimi S, De Corso E, Spriano G, Malvezzi L. Cross-Cultural Validation of the Short Version of the Questionnaire of Olfactory Disorders-Negative Statements into Italian: Towards Personalized Patient Care. J Pers Med 2022; 12:jpm12122010. [PMID: 36556231 PMCID: PMC9782898 DOI: 10.3390/jpm12122010] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/21/2022] [Accepted: 12/02/2022] [Indexed: 12/07/2022] Open
Abstract
Given the high burden of olfactory dysfunction worldwide, recently increased due to the COVID-19 pandemic, it is mandatory to adopt a specific questionnaire to assess the impact of olfactory impairment on quality of life, to be used in clinical practice. The aim of this study is to adapt and validate the short version of the Questionnaire of Olfactory Disorders-Negative Statements (svQOD-NS) for Italian. In the pilot phase, the Italian version of the questionnaire (ITA-svQOD-NS) was produced following recommended guidelines. It was then given to 50 healthy subjects and 50 patients (affected by either nasal polyposis or septal deviation), and results were compared to those of other widely used questionnaires. Test-retest reliability was assessed on a sample of 25 patients. All 50 patients repeated the questionnaires at one and nine months after surgery. The internal consistency of ITA-svQOD-NS measured with Cronbach α was excellent (α = 0.92). The intraclass correlation coefficient for test-retest reliability was also optimal (0.93; 95%CI: 0.90-0.96). Concurrent validity tested with the Pearson coefficient was significant with all other tests administered; also, concerning responsiveness, statistically significant differences were obtained between pre- and post-operative conditions. ITA-svQOD-NS showed high internal consistency, test-retest reliability, and significant correlation with all most-used clinical questionnaires; thus, it can be efficiently applied to assess olfaction-related QoL in the Italian population.
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Affiliation(s)
- Francesca Pirola
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Francesco Giombi
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Fabio Ferreli
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Andrea Costantino
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Giuseppe Mercante
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Giovanni Paoletti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Enrico Heffler
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Stefano Settimi
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy
| | - Eugenio De Corso
- Unit of Otorhinolaryngology-Head and Neck Surgery, A. Gemelli Hospital Foundation IRCCS, 00168 Rome, Italy
| | - Giuseppe Spriano
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Luca Malvezzi
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
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Longobardi Y, Galli J, Di Cesare T, D'Alatri L, Settimi S, Mele D, Bussu F, Parrilla C. Optimizing Pulmonary Outcomes After Total Laryngectomy: Crossover Study on New Heat and Moisture Exchangers. Otolaryngol Head Neck Surg 2022; 167:929-940. [PMID: 35316144 DOI: 10.1177/01945998221086200] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate the effects of new devices-heat and moisture exchangers (HMEs) and adhesives-on pulmonary symptoms, subject adherence, quality of life, dermatologic symptoms, and patient satisfaction after laryngectomy. STUDY DESIGN Prospective crossover study. SETTING Between December 2020 and April 2021, 40 patients were enrolled who had undergone laryngectomy, routinely used HMEs and adhesive, and were followed in our Department of Otolaryngology-Head and Neck Surgery. METHODS Patients were allocated into group A (new products) or group B (usual care) for 6 weeks. Then the 2 groups reversed, and each patient acted as his or her own control. Patients kept a diary and cough tally sheet. At baseline and after each 6-week period, 2 questionnaires were administered: EQ-5D (European Quality of Life-5 Dimensions) and CASA-Q (Cough and Sputum Assessment Questionnaire). RESULTS Six weeks of using new products resulted in the following effects for both groups: (1) a significant reduction in daily forced expectoration and dry coughs, (2) a significant improvement in all domains of the CASA-Q, (3) an increase in adherence to HME use, (4) a significant reduction in shortness of breath and skin irritation, and (5) significantly better scores in the anxiety/depression domain of the EQ-5D. CONCLUSION Achieving this reduction in patients who were already highly adherent to HME use is clinically relevant and underscores the importance of using better-performing HMEs that can compensate for the humidification deficit. Improving pulmonary symptomatology could reduce patient restrictions in daily life and avoidance of social activity, with a consequent positive effect on quality of life.
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Affiliation(s)
- Ylenia Longobardi
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Clinica di Otorinolaringoiatria, Roma-Università Cattolica del Sacro Cuore, Milan, Italy
| | - Jacopo Galli
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Clinica di Otorinolaringoiatria, Roma-Università Cattolica del Sacro Cuore, Milan, Italy
| | - Tiziana Di Cesare
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Clinica di Otorinolaringoiatria, Roma-Università Cattolica del Sacro Cuore, Milan, Italy
| | - Lucia D'Alatri
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Clinica di Otorinolaringoiatria, Roma-Università Cattolica del Sacro Cuore, Milan, Italy
| | - Stefano Settimi
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Clinica di Otorinolaringoiatria, Roma-Università Cattolica del Sacro Cuore, Milan, Italy
| | - Dario Mele
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Clinica di Otorinolaringoiatria, Roma-Università Cattolica del Sacro Cuore, Milan, Italy
| | - Francesco Bussu
- Otolaryngology Division, Azienda Ospedaliero Universitaria Sassari, Rome, Italy
| | - Claudio Parrilla
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Clinica di Otorinolaringoiatria, Roma-Università Cattolica del Sacro Cuore, Milan, Italy
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Torretta S, De Corso E, Nava N, Fraccaroli F, Ferrucci SM, Settimi S, Montuori C, Porru DP, Spanu C, D’Agostino G, Marzano AV, Pignataro L. Proposal for a Structured Outpatient Clinic for Dupilumab Treatment in Chronic Rhinosinusitis with Nasal Polyps in the First Year of Treatment. J Pers Med 2022; 12:jpm12101734. [PMID: 36294873 PMCID: PMC9605368 DOI: 10.3390/jpm12101734] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/14/2022] [Accepted: 10/16/2022] [Indexed: 11/30/2022] Open
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common disease of the nose and paranasal sinuses with important economic and sanitary burdens, as well as having a great impact on patients’ quality of life. In this field, a new therapeutic approach for those patients who have been described as affected by severe uncontrolled CRSwNP, resistant to medical and best surgical treatment, is represented by subcutaneous human monoclonal antibodies (including dupilumab) that block specific targets involved in the type 2 inflammatory pathway which most commonly drives CRSwNP pathophysiology. This paper aims to report our experience in the management of severe uncontrolled CRSwNP and, in particular, describe our diagnostic workup including baseline evaluation and follow-up visits in the first year of treatment. We also describe into detail our multidisciplinary approach to the disease. We finally report the outcomes of treatment in a real-life setting. In this outpatient real-life setting, our results confirmed the effectiveness of dupilumab in reducing the volume of nasal polyps and restoring nasal obstruction and sense of smell, as well as improving patients’ quality of life. The adherence to the dupilumab treatment was very high. The dose of administration was never modified in patients in the first year of treatment. All the patients respected the plan of the visits at proposed time points. We believe that the structural organization of our outpatient clinic appears to be functional: it allows us to study patients thoroughly before starting treatment and to make a proper follow-up after it starts. We believe that sharing both our strict clinical flowchart and growing experience with dupilumab with the medical community can lead to more standardized and effective pathways of care for CRSwNP patients.
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Affiliation(s)
- Sara Torretta
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Center of Excellence of Type 2 Inflammation, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
- Correspondence:
| | - Eugenio De Corso
- Unit of Otorhinolaryngology-Head and Neck Surgery, “A. Gemelli” Hospital Foundation IRCCS, 00168 Rome, Italy
| | - Nicolò Nava
- Faculty of medicine, Università degli Studi di Milano, 20122 Milan, Italy
| | - Francesca Fraccaroli
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Center of Excellence of Type 2 Inflammation, 20122 Milan, Italy
| | - Silvia Mariel Ferrucci
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Center of Excellence of Type 2 Inflammation, 20122 Milan, Italy
| | - Stefano Settimi
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy
| | - Claudio Montuori
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy
| | - Davide Paolo Porru
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy
| | - Camilla Spanu
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy
| | - Giuseppe D’Agostino
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy
| | - Angelo Valerio Marzano
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Center of Excellence of Type 2 Inflammation, 20122 Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Lorenzo Pignataro
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Center of Excellence of Type 2 Inflammation, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
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Sergi B, Settimi S, Federici G, Galloni C, Cantaffa C, De Corso E, Lucidi D. Factors Influencing Personalized Management of Vestibular Schwannoma: A Systematic Review. J Pers Med 2022; 12:jpm12101616. [PMID: 36294756 PMCID: PMC9605318 DOI: 10.3390/jpm12101616] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/21/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022] Open
Abstract
Management of vestibular schwannoma (VS) is a complex process aimed at identifying a clinical indication for fractionated stereotactic radiotherapy (sRT) or microsurgical resection or wait and scan (WS). The aim of the review was to clarify which patient and tumor parameters may lead to different therapeutic choices, with a view to a personalized VS approach. A systematic review according to Preferred Reporting Items for Systematic Review and Meta-Analysis criteria was conducted between February and March 2022. The authors defined six parameters that seemed to influence decision-making in VS management: 1-incidental VS; 2-tumor size; 3-tumor regrowth after sRT; 4-subtotal resection; 5-patients' age; 6-symptoms. The initial search yielded 3532 articles, and finally, 812 articles were included. Through a qualitative synthesis of the included studies, management strategies were evaluated and discussed. An individualized proposal of procedures is preferable as compared to a single gold-standard approach in VS decision-making. The most significant factors that need to be considered when dealing with a VS diagnosis are age, tumor size and hearing preservation issues.
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Affiliation(s)
- Bruno Sergi
- Department of Head, Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Unit of Otorhinolaryngology-Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Stefano Settimi
- Department of Head, Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Unit of Otorhinolaryngology-Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-0630154439
| | - Gaia Federici
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Costanza Galloni
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Carla Cantaffa
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Eugenio De Corso
- Unit of Otorhinolaryngology-Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Daniela Lucidi
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy
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De Corso E, Baroni S, Settimi S, Onori ME, Mastrapasqua RF, Troiani E, Moretti G, Lucchetti D, Corbò M, Montuori C, Cantiani A, Porru DP, Lo Verde S, Di Bella GA, Caruso C, Galli J. Sinonasal Biomarkers Defining Type 2-High and Type 2-Low Inflammation in Chronic Rhinosinusitis with Nasal Polyps. J Pers Med 2022; 12:jpm12081251. [PMID: 36013200 PMCID: PMC9410079 DOI: 10.3390/jpm12081251] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
The complex pathophysiology of chronic rhinosinusitis with nasal polyps (CRSwNP) generates a spectrum of phenotypes with a wide variety of inflammatory states. We enrolled 44 very-likely-to-be type 2 CRSwNP patients in order to evaluate the load of inflammation and to analyze human interleukins in nasal secretion. Clinical data were collected to evaluate the severity of the disease. High levels of IL-5, IL-4, IL-6, and IL-33 were detected in all type 2 CRSwNP patients. By analyzing type 2 cytokine profiles and local eosinophil count, we identified two coherent clusters: the first was characterized by high levels of IL-4, IL-5, IL-6, and a high-grade eosinophil count (type 2-high); the second had lower levels of cytokines and poor or absent eosinophilic inflammation (type-2 low). IL-5 levels were significantly higher within the type 2 cytokine and it was the most reliable biomarker for differentiating the two clusters. In type 2-high inflammatory profile clinical scores, the mean number of previous surgeries and need for systemic corticosteroids were significantly higher compared to type 2-low. Our research demonstrated the potential role of type 2 biomarkers, and in particular, of IL-5 in identifying patients with a more severe phenotype based on a high inflammatory load.
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Affiliation(s)
- Eugenio De Corso
- Unit of Otorhinolaryngology and Head-Neck Surgery, Fondazione Policlinico A. Gemelli IRCCS, 00168 Rome, Italy; (E.D.C.); (J.G.)
| | - Silvia Baroni
- Unit of Chemistry, Biochemistry and Molecular Biology, Fondazione Policlinico A. Gemelli IRCCS, 00168 Rome, Italy;
- Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.E.O.); (E.T.); (G.M.)
| | - Stefano Settimi
- Unit of Otorhinolaryngology and Head-Neck Surgery, Fondazione Policlinico A. Gemelli IRCCS, 00168 Rome, Italy; (E.D.C.); (J.G.)
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
- Correspondence: ; Tel.: +39-0630154439
| | - Maria Elisabetta Onori
- Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.E.O.); (E.T.); (G.M.)
| | - Rodolfo Francesco Mastrapasqua
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
| | - Eliana Troiani
- Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.E.O.); (E.T.); (G.M.)
| | - Giacomo Moretti
- Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.E.O.); (E.T.); (G.M.)
| | - Donatella Lucchetti
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Marco Corbò
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
| | - Claudio Montuori
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
| | - Alessandro Cantiani
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
| | - Davide Paolo Porru
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
| | - Simone Lo Verde
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
| | - Giuseppe Alberto Di Bella
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
| | - Cristiano Caruso
- Department of Medical and Surgical Sciences, Digestive Disease Center, Fondazione Policlinico A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Jacopo Galli
- Unit of Otorhinolaryngology and Head-Neck Surgery, Fondazione Policlinico A. Gemelli IRCCS, 00168 Rome, Italy; (E.D.C.); (J.G.)
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
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12
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Almadori G, Coli A, De Corso E, Mele DA, Settimi S, Di Cintio G, Brigato F, Scannone D, Lauriola L, Ranelletti FO. Parathyroid hormone-related peptide and parathyroid hormone-related peptide receptor type 1 in locally advanced laryngeal cancer as prognostic indicators of relapse and survival. BMC Cancer 2022; 22:704. [PMID: 35761298 PMCID: PMC9235225 DOI: 10.1186/s12885-022-09748-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 04/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background Parathyroid hormone-related peptide (PTHrP) overexpression and poor patient outcome have been reported for many human tumors, but no studies are available in laryngeal cancer. Therefore, we studied the expression of PTHrP and its receptor, parathyroid hormone-related peptide receptor type 1 (PTH1R), in primary locally advanced laryngeal squamous cell carcinomas (LALSCC) also in relation to the clinical outcome of patients. Methods We conducted a retrospective exploratory study, using immunohistochemistry, on PTHrP, PTH1R and HER1 expressions in LALSCC of 66 patients treated with bio-radiotherapy with cetuximab. Results The expressions of PTHrP and PTH1R in LALSCC were associated with the degree of tumor differentiation (p = 0.01 and 0.04, respectively). Poorly differentiated tumors, with worse prognosis, expressed PTHrP at nuclear level and were PTH1R negative. PTHrP and PTH1R were expressed at cytoplasmic level in normal larynx epithelium and more differentiated laryngeal cancer cells, suggesting an autocrine/paracrine role of PTHrP in squamous cell differentiation of well differentiated tumors with good prognosis. Eighty-one percent HER1 positive tumors expressed PTHrP (p < 0.0001), mainly at nuclear level, consistent with the known up-regulation of PTHrP gene by HER1 signaling. In multivariable analyses, patients with PTHrP positive tumors had a higher relative risk of relapse (HR = 5.49; CI 95% = 1.62–22.24; p = 0.006) and survival (HR = 8.21; CI 95% = 1.19–105.00; p = 0.031) while those with PTH1R positive tumors showed a lower relative risk of relapse (HR = 0.18; CI 95% = 0.04–0.62; p = 0.002) and survival (HR = 0.18; CI 95% = 0.04–0.91; p = 0.029). Conclusions In LALSCC nuclear PTHrP and absence of PTH1R expressions could be useful in predicting response and/or resistance to cetuximab in combined therapies, contributing to an aggressive behavior of tumor cells downstream to HER1. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09748-1.
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Massaccesi M, Dinapoli N, Fuga V, Rupe C, Panfili M, Calandrelli R, Settimi S, Olivieri M, Bartoli FB, Mazzarella C, Longo S, Lajolo C, Boldrini L, Gambacorta MA, Valentini V, Miccichè F. A predictive nomogram for trismus after radiotherapy for head and neck cancer. Radiother Oncol 2022; 173:231-239. [PMID: 35662658 DOI: 10.1016/j.radonc.2022.05.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 12/19/2021] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The aim of this study is to develop a prediction model for trismus (maximal interincisal distance equal to or less than 35 millimeters) based on a multivariable analysis of dosimetric and clinical factors METHODS: The Maximum inter-incisal opening (MIO) of HNC patients who underwent radiotherapy (RT) +/- concurrent chemotherapy with radical intent was prospectively measured prior to RT (baseline) and 6 months post-RT. The outcome variable is trismus. The potential risk factors (clinical and dosimetric) were first screened by univariate analysis and then by multivariate analysis. At the end of this process, we used the features identified as relevant to fit a logistic regression model and calculate the probability of observed trismus during the 6-month follow-up after radiation treatment. RESULTS One hundred and four consecutive patients were included (mean age 63 years, range 25-87), 68 were males, 36 females. In the univariate analysis, the MIO at baseline, as an independent variable, and several Vdoses of different masticatory structures were found as significant. Additionally, using a bivariate model, a feature selection process was performed. Finally, we considered as best performing model the MIO at baseline and V42 at Masseter Muscle. The area under curve (AUC) of Receiver Operating Characteristic (ROC) curve value of 0,8255 (95% CI 0.74-0.9). The Hosmer and Lemeshow goodness-of-fit test, used to calibrate our model, is non-significant. CONCLUSIONS A prediction nomogram was developed to assess trismus risk in planning process. An external validation of the model is required to apply it for current clinical use.
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Affiliation(s)
- Mariangela Massaccesi
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Nicola Dinapoli
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Valentina Fuga
- Università Cattolica del Sacro Cuore, Rome, Italy; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Largo Agostino Gemelli, Roma, Italy
| | - Cosimo Rupe
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Panfili
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma-UOC Radiologia e Neuroradiologia, Polo Diagnostica Per Immagini, Radioterapia, Oncologia ed Ematologia, Area Diagnostica Per Immagini, 00168 Rome, Italy
| | - Rosalinda Calandrelli
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma-UOC Radiologia e Neuroradiologia, Polo Diagnostica Per Immagini, Radioterapia, Oncologia ed Ematologia, Area Diagnostica Per Immagini, 00168 Rome, Italy
| | - Stefano Settimi
- Division of Otorhinolaryngology, Department of Aging, Neuroscience, Orthopedics and Head and Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Francesco Beghella Bartoli
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Ciro Mazzarella
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Silvia Longo
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Carlo Lajolo
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Boldrini
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Antonietta Gambacorta
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Vincenzo Valentini
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
| | - Francesco Miccichè
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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14
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De Corso E, Baroni S, Onori ME, Tricarico L, Settimi S, Moretti G, Troiani E, Mastrapasqua RF, Furno D, Crudo F, Urbani A, Galli J. Calprotectin in nasal secretion: a new biomarker of non-type 2 inflammation in CRSwNP. Acta Otorhinolaryngol Ital 2022; 42:355-363. [PMID: 35775497 PMCID: PMC9577689 DOI: 10.14639/0392-100x-n1800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/15/2022] [Indexed: 01/10/2023]
Abstract
Objective We analysed calprotectin in sinonasal secretions of different chronic rhinosinusitis with nasal polyps (CRSwNP) endotypes to assess its role as a biomarker of non-type 2 inflammation. Methods We included primary diffuse CRSwNP patients (n = 41) and three different control groups [non-allergic rhinitis (NAR) (n = 13), non-allergic eosinophilic syndrome (NARES) (n = 10) and healthy subjects (n = 12)]. Calprotectin levels were detected in nasal secretions using a chemiluminescent immunoassay (CLIA). Results Calprotectin levels in nasal secretions were significantly higher in all non-type 2 endotypes of CRSwNP compared to healthy controls (p < 0.05). In contrast, in type-2 CRSwNP calprotectin was significantly lower compared to controls (p < 0.05). A significant correlation between calprotectin levels and neutrophilic count/HPF was found in CRSwNP (p < 0.01). Clinically, mean levels of calprotectin and neutrophilia were significantly higher in patients who previously underwent 3 or more endoscopic sinus surgeries (p < 0.05). Conclusions Calprotectin in nasal secretions may be a biomarker of non-type 2 inflammation. Low levels of calprotectin are indicative of a type-2 immune response in both CRSwNP and non-allergic rhinitis. We observed that calprotectin levels significantly increased based on the number of previous surgeries.
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15
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De Corso E, Settimi S, Montuori C, Corbò M, Passali GC, Porru DP, Lo Verde S, Spanu C, Penazzi D, Di Bella GA, Nucera E, Bonini M, Paludetti G, Galli J. Effectiveness of Dupilumab in the Treatment of Patients with Severe Uncontrolled CRSwNP: A "Real-Life" Observational Study in the First Year of Treatment. J Clin Med 2022; 11:jcm11102684. [PMID: 35628815 PMCID: PMC9146210 DOI: 10.3390/jcm11102684] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [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: 04/15/2022] [Revised: 04/28/2022] [Accepted: 05/07/2022] [Indexed: 01/27/2023] Open
Abstract
The aim of this study was to evaluate the efficacy of dupilumab in the treatment of severe uncontrolled Chronic Rhinosinusitis with Nasal Polyps (CRSwNP), with or without asthma as add-on therapy with intra-nasal corticosteroids in a real-life setting over the first year of treatment. Our data demonstrated that subcutaneous 300 mg dupilumab administered at home via a pre-filled auto-injector every two weeks, based on indications set by the Italian Medicines Agency, was rapidly effective in reducing the size of polyps, decreasing symptoms of disease, improving quality of life, and recovering olfaction. Significant improvement was observed after only 15 days of treatment, and it progressively increased at 6 and 12 months. Dupilumab was also effective in reducing the local nasal eosinophilic infiltrate, in decreasing the need for surgery and/or oral corticosteroids, and in improving control of associated comorbidities such as chronic eosinophilic otitis media and bronchial asthma. After 12 months of treatment, 96.5% of patients had a moderate/excellent response. From our data, it was evident that there was a group of patients that showed a very early response within one month of therapy, another group with early response within six months from baseline, and a last group that improved later within 12 months. The results of this study support the use of dupilumab as an effective option in the current standard of care for patients affected by severe uncontrolled CRSwNP.
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Affiliation(s)
- Eugenio De Corso
- Unit of Otorhinolaryngology—Head and Neck Surgery, A. Gemelli Hospital Foundation IRCCS, 00168 Rome, Italy; (E.D.C.); (G.C.P.); (G.P.); (J.G.)
| | - Stefano Settimi
- Unit of Otorhinolaryngology—Head and Neck Surgery, A. Gemelli Hospital Foundation IRCCS, 00168 Rome, Italy; (E.D.C.); (G.C.P.); (G.P.); (J.G.)
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy; (C.M.); (M.C.); (D.P.P.); (S.L.V.); (C.S.); (D.P.); (G.A.D.B.)
- Correspondence: ; Tel.: +39-063-015-4149
| | - Claudio Montuori
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy; (C.M.); (M.C.); (D.P.P.); (S.L.V.); (C.S.); (D.P.); (G.A.D.B.)
| | - Marco Corbò
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy; (C.M.); (M.C.); (D.P.P.); (S.L.V.); (C.S.); (D.P.); (G.A.D.B.)
| | - Giulio Cesare Passali
- Unit of Otorhinolaryngology—Head and Neck Surgery, A. Gemelli Hospital Foundation IRCCS, 00168 Rome, Italy; (E.D.C.); (G.C.P.); (G.P.); (J.G.)
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy; (C.M.); (M.C.); (D.P.P.); (S.L.V.); (C.S.); (D.P.); (G.A.D.B.)
| | - Davide Paolo Porru
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy; (C.M.); (M.C.); (D.P.P.); (S.L.V.); (C.S.); (D.P.); (G.A.D.B.)
| | - Simone Lo Verde
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy; (C.M.); (M.C.); (D.P.P.); (S.L.V.); (C.S.); (D.P.); (G.A.D.B.)
| | - Camilla Spanu
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy; (C.M.); (M.C.); (D.P.P.); (S.L.V.); (C.S.); (D.P.); (G.A.D.B.)
| | - Daniele Penazzi
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy; (C.M.); (M.C.); (D.P.P.); (S.L.V.); (C.S.); (D.P.); (G.A.D.B.)
| | - Giuseppe Alberto Di Bella
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy; (C.M.); (M.C.); (D.P.P.); (S.L.V.); (C.S.); (D.P.); (G.A.D.B.)
| | - Eleonora Nucera
- Unit of Allergology, A. Gemelli Hospital Foundation IRCCS, 00168 Rome, Italy;
- Department of Internal Medicine and Geriatrics, Catholic University of the Sacred Hearth, 00168 Rome, Italy;
| | - Matteo Bonini
- Department of Internal Medicine and Geriatrics, Catholic University of the Sacred Hearth, 00168 Rome, Italy;
- Unit of Pulmonology, A. Gemelli Hospital Foundation IRCCS, 00168 Rome, Italy
| | - Gaetano Paludetti
- Unit of Otorhinolaryngology—Head and Neck Surgery, A. Gemelli Hospital Foundation IRCCS, 00168 Rome, Italy; (E.D.C.); (G.C.P.); (G.P.); (J.G.)
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy; (C.M.); (M.C.); (D.P.P.); (S.L.V.); (C.S.); (D.P.); (G.A.D.B.)
| | - Jacopo Galli
- Unit of Otorhinolaryngology—Head and Neck Surgery, A. Gemelli Hospital Foundation IRCCS, 00168 Rome, Italy; (E.D.C.); (G.C.P.); (G.P.); (J.G.)
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy; (C.M.); (M.C.); (D.P.P.); (S.L.V.); (C.S.); (D.P.); (G.A.D.B.)
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16
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Massaccesi M, Fuga V, Dinapoli N, Rupe C, Olivieri M, Beghella Bartoli F, Mazzarella C, Panfili M, Calandrelli R, Settimi S, Lajolo C, Gambacorta M, Miccichè F. PD-0827 Dose volume correlates of mouth opening reduction after radiotherapy for HNC: comprehensive analysis. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02968-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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17
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Galli J, Di Cintio G, Settimi S, Salvati A, Parrilla C, Almadori G, Paludetti G. Elective Neck Dissection during Salvage Total Laryngectomy: Personal Experience. J Clin Med 2022; 11:jcm11051438. [PMID: 35268528 PMCID: PMC8911131 DOI: 10.3390/jcm11051438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/14/2022] [Accepted: 02/25/2022] [Indexed: 11/16/2022] Open
Abstract
The role of elective neck dissection during salvage surgery in patients with a clinically negative neck (cN0) is still discussed. The main objective of this work was to estimate the prevalence and predictive factors of occult neck nodes metastasis; we therefore aimed to evaluate the survival rate and the main oncologic outcomes of cN0 patients who underwent salvage total laryngectomy and elective bilateral neck dissection. In this retrospective observational study, we enrolled 80 cN0 patients affected by recurrent laryngeal cancer and who underwent salvage total laryngectomy and bilateral selective elective neck dissection. Several parameters were collected in order to find prognostic factors; finally, postoperative complications were reviewed and survival analysis was performed. Occult lymph node metastases were reported in 18 out of 80 patients (22.5%). Significant statistical correlation between lymphovascular invasion (p = 0.007), perineural invasion (p = 0.025) and occult nodal metastasis was found. Other variables (glottic subsite of recurrence, clinical T, pathological T, previous chemotherapy) were not significantly predictive of occult nodal metastasis. The 5-year OS, DSS, and RFS were 50.4%, 64.7%, and 63.4%, respectively. In conclusion, our single-institution data on a large cohort of patients, suggest performing routinely elective selective bilateral neck dissection during salvage total laryngectomy in cN0 patients due to the biological attitude of the tumor to spread to cervical nodes, considering an acceptable complications rate.
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Affiliation(s)
- Jacopo Galli
- Unit of Otolaryngology—Head and Neck Surgery, “A. Gemelli” Hospital Foundation IRCCS, 00168 Rome, Italy; (J.G.); (C.P.); (G.A.); (G.P.)
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy
| | - Giovanni Di Cintio
- Unit of Otolaryngology, “Nuovo Ospedale Degli Infermi”, 13875 Ponderano, Italy;
| | - Stefano Settimi
- Unit of Otolaryngology—Head and Neck Surgery, “A. Gemelli” Hospital Foundation IRCCS, 00168 Rome, Italy; (J.G.); (C.P.); (G.A.); (G.P.)
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-06-30154149
| | - Antonio Salvati
- Airway Surgery Unit, Pediatric Surgery Department, “Bambino Gesù” Children Hospital, 00165 Rome, Italy;
| | - Claudio Parrilla
- Unit of Otolaryngology—Head and Neck Surgery, “A. Gemelli” Hospital Foundation IRCCS, 00168 Rome, Italy; (J.G.); (C.P.); (G.A.); (G.P.)
| | - Giovanni Almadori
- Unit of Otolaryngology—Head and Neck Surgery, “A. Gemelli” Hospital Foundation IRCCS, 00168 Rome, Italy; (J.G.); (C.P.); (G.A.); (G.P.)
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy
| | - Gaetano Paludetti
- Unit of Otolaryngology—Head and Neck Surgery, “A. Gemelli” Hospital Foundation IRCCS, 00168 Rome, Italy; (J.G.); (C.P.); (G.A.); (G.P.)
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy
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18
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Prampolini C, Almadori G, Bonvissuto D, Barba M, Giraldi L, Boccia S, Paludetti G, Galli J, Parolini O, Settimi S, Cadoni G. Immunohistochemical detection of "ex novo" HLA-DR in tumor cells determines clinical outcome in laryngeal cancer patients. HLA 2021; 98:517-524. [PMID: 34605215 DOI: 10.1111/tan.14441] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 09/27/2021] [Accepted: 09/30/2021] [Indexed: 12/09/2022]
Abstract
There are controversial results about the role of "ex novo" HLA-DR expression by tumor cells and its correlation with the oncological outcomes. Unfortunately, little is known about HLA-DR expression in laryngeal cancer tumor cells. The main purpose of this retrospective study is to strengthen the usefulness of studying "ex novo" HLA-DR expression on tumor cells from primary laryngeal squamous cell carcinoma (LSCC) patients and investigate its correlation with clinical outcome. We analyzed HLA-DR expression by immunohistochemical analysis in 56 patients with LSCC. The "ex novo" HLA-DR expression on laryngeal cancer tumor cells, assessing non-neoplastic LSCC - adjacent tissue, and the association of HLA-DR expression (HLA-DR+) with clinical outcomes were investigated. HLA-DR+ tumor cells were detected in 18/56 LSCC patients (32.1%). All specimens of non-neoplastic laryngeal carcinoma-adjacent tissue resulted HLA-DR negative (HLA-DR-). A statistically significant association was observed between HLA-DR + and well differentiated tumors (G1) (p<0.001). The Kaplan-Meier method showed how HLA-DR+ is significantly associated with both a better disease specific survival (HLA-DR+=100% vs. HLA-DR-=77.4%; p=0.047) and a better relapse free survival (HLA-DR+=100% vs. HLA-DR-=72.3%; p=0.021). Cox regression univariate analysis for death of disease confirmed a higher HR for HLA-DR absence on the surface of epithelial tumor cell [HR:37.489; 95% CI:0.750-18730.776; p=0.253] and for high-grade (G3) tumors [HR:18.601; 95% CI:3.613-95.764; p<0.0001]. Our results confirm that MHC class II HLA-DR expression is activated in a sub-set of LSCC patients. Evaluation of HLA-DR expression in LSCC could be useful for prognosis and future approaches towards personalized therapy.
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Affiliation(s)
- Chiara Prampolini
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Almadori
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Aging, Neurologic, Orthopedic and Head-Neck Sciences, Otorhinolaryngology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Davide Bonvissuto
- Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marta Barba
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.,Biobank for Personalized Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Giraldi
- Department of Life Science and Public Health, Section of Hygiene and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefania Boccia
- Department of Life Science and Public Health, Section of Hygiene and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Woman and Child Health and Public Health, Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gaetano Paludetti
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Aging, Neurologic, Orthopedic and Head-Neck Sciences, Otorhinolaryngology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Jacopo Galli
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Aging, Neurologic, Orthopedic and Head-Neck Sciences, Otorhinolaryngology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ornella Parolini
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.,Biobank for Personalized Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Stefano Settimi
- Department of Aging, Neurologic, Orthopedic and Head-Neck Sciences, Otorhinolaryngology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gabriella Cadoni
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Aging, Neurologic, Orthopedic and Head-Neck Sciences, Otorhinolaryngology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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19
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Almadori G, Coli A, De Corso E, Mele DA, Settimi S, Di Cintio G, Brigato F, Scannone D, Carey TE, Paludetti G, Lauriola L, Ranelletti FO. Nuclear HER3 expression improves the prognostic stratification of patients with HER1 positive advanced laryngeal squamous cell carcinoma. J Transl Med 2021; 19:408. [PMID: 34579737 PMCID: PMC8477517 DOI: 10.1186/s12967-021-03081-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/02/2021] [Accepted: 09/14/2021] [Indexed: 11/24/2022] Open
Abstract
Background Compared to the other members of human epidermal growth factor family receptors (HER), the role of HER3 has not been well defined in laryngeal cancer. The predictive and prognostic role of HER3 has been the focus of clinical attention but the research findings are contradictory, especially in laryngeal squamous cell carcinoma (LSCC). The variable localization of HER3 within cancer cells and the role of HER3 in primary and acquired resistance to HER1-targeted therapies remain unclear. Methods We performed a retrospective analysis of two cohorts of 66 homogeneous consecutive untreated primary advanced LSCC patients, in which co-expression of HER1, HER2 and HER3 receptors was investigated by semi-quantitative immunohistochemistry. The association of their pattern of expression with survival was evaluated by Kaplan–Meier and Cox’s proportional hazard analyses. Multivariable Cox proportional hazards models were developed to predict median 2- and 3-year RFS and 2.5- and 5-year OS. The Akaike information criterion technique and backwards stepwise procedure were used for model selections. The performance of the final Cox models was assessed with respect to calibration and discrimination. Results Immunohistochemical labeling for HER1 and HER2 was localized both in the cell membrane and in the cytoplasm, while HER3 labeling was observed both in the cell cytoplasm and in the nucleus. HER3 expression was inversely correlated with HER1 positivity. The expression patterns of HERs were associated with tumor differentiation. In both cohorts of patients, HER1 expression was associated with reduced relapse-free (RFS) and overall survival (OS). In HER1 positive tumors, the co-expression with nuclear HER3 was associated with better RFS and OS, compared with HER3 negative tumors or tumors expressing HER3 at cytoplasmic level. HER3 expressing tumors had a higher Geminin/MCM7 ratio than HER3 negative ones, regardless of HER1 co-expression. Multivariable analyses identified age at diagnosis, tumor site, HER1, HER3 and age at diagnosis, tumor stage, HER1, HER3, as covariates significantly associated with RFS and OS, respectively. Bootstrapping verified the good fitness of these models for predicting survivals and the optimism-corrected C-indices were 0.76 and 0.77 for RFS and OS, respectively. Conclusions Nuclear HER3 expression was strongly associated with favourable prognosis and allows to improve the prognostic stratification of patients with HER1 positive advanced LSCC carcinoma. Supplementary Information The online version contains supplementary material available at 10.1186/s12967-021-03081-0.
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Affiliation(s)
- Giovanni Almadori
- Unit of Head and Neck Oncology, "A. Gemelli" University Hospital Foundation IRCCS-Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy. .,Unit of Otorhinolaryngology, "A. Gemelli" University Hospital Foundation IRCCS, Roma, Italy. .,Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Antonella Coli
- Università Cattolica del Sacro Cuore, Roma, Italy.,Unit of Anatomic Pathology, "A. Gemelli" University Hospital Foundation IRCCS, Roma, Italy
| | - Eugenio De Corso
- Unit of Otorhinolaryngology, "A. Gemelli" University Hospital Foundation IRCCS, Roma, Italy
| | - Dario Antonio Mele
- Unit of Otorhinolaryngology, "A. Gemelli" University Hospital Foundation IRCCS, Roma, Italy
| | - Stefano Settimi
- Unit of Otorhinolaryngology, "A. Gemelli" University Hospital Foundation IRCCS, Roma, Italy
| | - Giovanni Di Cintio
- Unit of Otorhinolaryngology, "A. Gemelli" University Hospital Foundation IRCCS, Roma, Italy
| | - Francesca Brigato
- Unit of Otorhinolaryngology, "A. Gemelli" University Hospital Foundation IRCCS, Roma, Italy
| | - Domenico Scannone
- Unit of Anatomic Pathology, "A. Gemelli" University Hospital Foundation IRCCS, Roma, Italy
| | - Thomas E Carey
- Department of Otolaryngology/Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Gaetano Paludetti
- Unit of Otorhinolaryngology, "A. Gemelli" University Hospital Foundation IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Libero Lauriola
- Università Cattolica del Sacro Cuore, Roma, Italy.,Unit of Anatomic Pathology, "A. Gemelli" University Hospital Foundation IRCCS, Roma, Italy
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20
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Almadori G, De Corso E, Settimi S, Di Cintio G, Mele DA, Brigato F, Paludetti G, Salgarello M. When is a surgical multidisciplinary approach required in the management of head and neck non-melanoma skin cancer and in advanced head and neck pathologies involving skin? ACTA ACUST UNITED AC 2021; 41:S145-S157. [PMID: 34060530 PMCID: PMC8172116 DOI: 10.14639/0392-100x-suppl.1-41-2021-15] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/14/2021] [Indexed: 11/28/2022]
Abstract
Non-melanoma Skin cancer, including cutaneous squamous cell carcinoma and basal cell carcinoma, is the most common form of malignancy in the Caucasian population, and the skin of the head and neck is the site most involved. They should not be underestimated; in particular, high-risk lesions and advanced skin cancers require accurate diagnostic work up, aggressive surgical treatment and should be managed by the head and neck surgeon, the dermatologist and the plastic surgeon. Cutaneous head-neck malignancies are often overlooked or not routinely treated with a multidisciplinary surgical approach. Similarly, for primary head and neck cancers with involvement of surrounding skin, the involvement of the dermatologist and the plastic surgeon could better define an adequate diagnosis and treatment planning. The management of these patients presents both therapeutic and ethical problems, because the poor prognosis is burdened by facial disfigurement, open malodorous wounds and intractable pain. Therefore, in patients with advanced disease that is not candidate to radical surgery, palliative surgery with flap reconstruction could take place and could be proposed to improve quality of life.
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Affiliation(s)
- Giovanni Almadori
- Cervico-Facial Oncological Surgery Unit, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Eugenio De Corso
- Otorhinolaryngology and Head-Neck Surgery Unit, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Stefano Settimi
- Otorhinolaryngology and Head-Neck Surgery Unit, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Di Cintio
- Otorhinolaryngology and Head-Neck Surgery Unit, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Dario Antonio Mele
- Otorhinolaryngology and Head-Neck Surgery Unit, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesca Brigato
- Otorhinolaryngology and Head-Neck Surgery Unit, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Gaetano Paludetti
- Otorhinolaryngology and Head-Neck Surgery Unit, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Marzia Salgarello
- Plastic and Reconstructive Surgery Unit, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
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21
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Fetoni AR, Di Cesare T, Settimi S, Sergi B, Rossi G, Malesci R, Marra C, Paludetti G, De Corso E. The evaluation of global cognitive and emotional status of older patients with chronic tinnitus. Brain Behav 2021; 11:e02074. [PMID: 34288570 PMCID: PMC8413806 DOI: 10.1002/brb3.2074] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/26/2021] [Accepted: 02/05/2021] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Tinnitus is a common symptom largely impactful on quality of life, especially in the elderly. Our aim was to evaluate the efficacy of self-administered screening tests to correlate the severity of subjective perception of tinnitus with emotional disorders and the overall cognitive status. METHODS Patients aged ≥ 55 years with chronic tinnitus were recruited and submitted to a complete audiological evaluation; Tinnitus Handicap inventory (THI); Hospital Anxiety and Depression Scale (HADS-A and HADS-D) and Mini-Mental State Examination (MMSE). Demographic and audiological features of patients with and without cognitive impairment (MMSE score cut-off of 24/30) were analyzed in order to reveal the relationship among tinnitus, emotional disorders, and cognitive dysfunction. RESULTS 102 patients were recruited (mean age: 70.4 ± 9.6). THI score was directly related to HADS-A score (r = .63) HADS-D score (r = .66), whereas there was no relationship between tinnitus severity and MMSE (r = .13). CI and n-CI groups did not differ in the characteristics of tinnitus (p > .05), however, hearing threshold (p = .049) and anxious depressive traits measured with HADS-A (p = .044) and HADS-D (p = .016) were significantly higher in the group with cognitive impairment. Furthermore, age ≥ 75 years (p = .002, OR = 13.8), female sex (p = .032; OR = 6.5), severe hearing loss (p = .036; OR = 2.3), and anxiety (p = .029; OR = 9.2) resulted risk factors for CI. Therefore, in CI group MMSE score was inversely related to age (r = -.84). CONCLUSIONS Cognitive impairment and psychiatric discomfort should be considered in tinnitus patients, related to increasing age, female sex, and severe hearing loss. Thus, self-administered questionnaires can be useful in addressing clinical approach.
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Affiliation(s)
- Anna Rita Fetoni
- Institute of Otolaryngology, Fondazione Policlinico Agostino Gemelli, IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Bruno Sergi
- Institute of Otolaryngology, Fondazione Policlinico Agostino Gemelli, IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Rita Malesci
- Audiology and Vestibology Unit, Neuroscience Department, Federico II University Naples, Naples, Italy
| | - Camillo Marra
- Università Cattolica del Sacro Cuore, Rome, Italy.,Memory Clinic, Fondazione Policlinico Agostino Gemelli, IRCCS, Rome, Italy
| | - Gaetano Paludetti
- Institute of Otolaryngology, Fondazione Policlinico Agostino Gemelli, IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eugenio De Corso
- Institute of Otolaryngology, Fondazione Policlinico Agostino Gemelli, IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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22
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De Corso E, Mastrapasqua RF, Fiorita A, Settimi S, Mele DA, Picciotti PM, Loperfido A, Marrone S, Rizzotto G, Paludetti G, Scarano E. Efficacy and long-term follow-up of positional therapy by vibrotactile neck-based device in the management of positional OSA. J Clin Sleep Med 2021; 16:1711-1719. [PMID: 32621579 DOI: 10.5664/jcsm.8664] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
STUDY OBJECTIVES Different therapeutic strategies have been investigated for the treatment of positional obstructive sleep apnea, but more evidence is needed about efficacy and compliance. The objective of this study was to describe the efficacy of vibrotactile neck-based treatment in patients with positional obstructive sleep apnea with different degrees of obstructive sleep apnea severity who were followed for 6 months. METHODS This is a retrospective study including 162 patients with positional obstructive sleep apnea undergoing vibrotactile neck-based positional therapy. We compared polysomnographic data obtained at baseline and during positional therapy after 1 month. We performed a subgroup analysis based on obstructive sleep apnea severity. Furthermore, we analyzed follow-up data in 84/162 (51.8%) patients with particular focus on discontinuation and complications related to the device. RESULTS We observed a significant difference between mean baseline obstructive apnea-hypopnea index (OAHI; 21.9 ± 9.9 events/h) and during positional therapy (12 ± 9.2 events/h; P < .01). Moreover, 87/162 (54.9%) patients showed a reduced baseline OAHI of at least 50% and 38/162 (23.4%) achieved complete disease control (OAHI < 5 events/h). At subgroup analysis, at least 50% reduction from baseline OAHI was observed in 56.8% of patients with mild, 55% with moderate, and 47.4% with severe OAHI, whereas complete control of disease was achieved in 50% of patients with mild, 22.5% with moderate, and 7.9% with severe OAHI. At a 6-month follow-up, only 35/84 patients (41.6%) were regularly using the device, with a mean of 5.9 ± 1.2 days per week. CONCLUSIONS Our results on the efficacy and long-term adherence to vibrotactile neck-based positional therapy showed that positional therapy can be an efficient first-line treatment option for mild positional obstructive sleep apnea and in selected cases of moderate disease. Long-term compliance is limited because of complications and low satisfaction in some patients.
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Affiliation(s)
- Eugenio De Corso
- Unit of Otorhinolaryngology and Head and Neck Surgery. Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Rome, Italy.,Head and Neck Department, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Antonella Fiorita
- Unit of Otorhinolaryngology and Head and Neck Surgery. Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Rome, Italy.,Head and Neck Department, Catholic University of the Sacred Heart, Rome, Italy
| | - Stefano Settimi
- Head and Neck Department, Catholic University of the Sacred Heart, Rome, Italy
| | - Dario Antonio Mele
- Head and Neck Department, Catholic University of the Sacred Heart, Rome, Italy
| | - Pasqualina Maria Picciotti
- Unit of Otorhinolaryngology and Head and Neck Surgery. Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Rome, Italy.,Head and Neck Department, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonella Loperfido
- Head and Neck Department, Catholic University of the Sacred Heart, Rome, Italy
| | - Sabino Marrone
- Head and Neck Department, Catholic University of the Sacred Heart, Rome, Italy
| | - Grazia Rizzotto
- Head and Neck Department, Catholic University of the Sacred Heart, Rome, Italy.,Unit of Neurophysiopathology. Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Gaetano Paludetti
- Unit of Otorhinolaryngology and Head and Neck Surgery. Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Rome, Italy.,Head and Neck Department, Catholic University of the Sacred Heart, Rome, Italy
| | - Emanuele Scarano
- Unit of Otorhinolaryngology and Head and Neck Surgery. Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Rome, Italy.,Head and Neck Department, Catholic University of the Sacred Heart, Rome, Italy
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23
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Berrone M, Lajolo C, De Corso E, Settimi S, Rupe C, Crosetti E, Succo G. Cooperation between ENT surgeon and dentist in head and neck oncology. ACTA ACUST UNITED AC 2021; 41:S124-S137. [PMID: 34060528 PMCID: PMC8172104 DOI: 10.14639/0392-100x-suppl.1-41-2021-13] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/08/2021] [Indexed: 01/19/2023]
Affiliation(s)
- Mattia Berrone
- Head and Neck Oncology Service, Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Italy.,Department of Oncology, University of Turin, Turin, Italy
| | - Carlo Lajolo
- Head and Neck Department, "Fondazione Policlinico Universitario A. Gemelli - IRCCS" Rome, Italy.,School of Dentistry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eugenio De Corso
- Head and Neck Department, "Fondazione Policlinico Universitario A. Gemelli - IRCCS" Rome, Italy
| | - Stefano Settimi
- Head and Neck Department, "Fondazione Policlinico Universitario A. Gemelli - IRCCS" Rome, Italy
| | - Cosimo Rupe
- Head and Neck Department, "Fondazione Policlinico Universitario A. Gemelli - IRCCS" Rome, Italy
| | - Erika Crosetti
- Head and Neck Oncology Service, Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Italy
| | - Giovanni Succo
- Head and Neck Oncology Service, Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Italy.,Department of Oncology, University of Turin, Turin, Italy
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24
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Galli J, Settimi S, Mele DA, Salvati A, Schiavi E, Parrilla C, Paludetti G. Role of Narrow Band Imaging Technology in the Diagnosis and Follow up of Laryngeal Lesions: Assessment of Diagnostic Accuracy and Reliability in a Large Patient Cohort. J Clin Med 2021; 10:jcm10061224. [PMID: 33809578 PMCID: PMC8002249 DOI: 10.3390/jcm10061224] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 12/31/2020] [Revised: 02/19/2021] [Accepted: 03/01/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aim of this study was to assess diagnostic accuracy and reliability of narrow band imaging (NBI) in the differential diagnosis of laryngeal premalignant lesion, early cancers and recurrences. MATERIAL AND METHODS We enrolled 231 patients who underwent endoscopic examination with white light endoscopy (WLE) + NBI and divided them into two groups, group A, without previous radiochemotherapy and group B, with previous radiochemotherapy. When indicated, we performed surgical biopsies to evaluate sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy and likelihood of endoscopic examination comparing WLE alone and WLE + NBI. RESULTS A positive NBI lesion, compared with a negative NBI lesion, had a 29.68 (group A) and 13.96 (group B) times higher probability to be histologically positive (i.e., confirmed) compared with WLE alone improving the diagnostic accuracy. In group A, the NBI mode showed excellent sensitivity (95.0%), which was higher than WLE 2 mode (77.5%). However, the greatest differences were recorded regarding specificity (96.8% vs. 40.6%). In group B, both NBI alone and WLE + NBI mode showed a 94.1% specificity compared with WLE alone, which had a maximum specificity of 85.3%. The mode comparison between NBI and WLE in both groups showed a statistically significant difference, with p-values <0.0001. CONCLUSIONS NBI represents a reliable technology in challenging situations, especially in the context of post-radiotherapy or post-surgical mucosal changes showing a high NPV. NBI could reduce the number of unnecessary biopsies related to increased microvascular anomaly revelation, which could help to identify early-stage lesions suitable for minimally invasive surgery and, consequently, decrease hospital admissions.
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Affiliation(s)
- Jacopo Galli
- Institute of Otorhinolaryngology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (J.G.); (C.P.); (G.P.)
- Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Stefano Settimi
- Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Dario Antonio Mele
- Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
- Correspondence: ; Tel.: +39-063-015-4439
| | - Antonio Salvati
- Airway Surgery Unit, Pediatric Surgery Department, Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
| | - Enrico Schiavi
- Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Claudio Parrilla
- Institute of Otorhinolaryngology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (J.G.); (C.P.); (G.P.)
| | - Gaetano Paludetti
- Institute of Otorhinolaryngology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (J.G.); (C.P.); (G.P.)
- Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
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25
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Marchese MR, Bussu F, Settimi S, Scarano E, Almadori G, Galli J. Not only gustatory sweating and flushing: Signs and symptoms associated to the Frey syndrome and the role of botulinum toxin A therapy. Head Neck 2020; 43:949-955. [PMID: 33247501 DOI: 10.1002/hed.26561] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 11/12/2020] [Accepted: 11/18/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The classic symptoms of Frey syndrome are gustatory sweating and flushing. Aims of the study were to describe prevalenceand severity of typical and atypical presentations of the disorder and to assess the effects of botulinum neurotoxin A (BoNT-A) therapy in patients with Frey syndrome after parotidectomy. METHODS In this prospective, observational study on 18 patients, we assessed symptom severity before therapy, after 15 days, 1, 3 and 6 months' follow-up with the sweating-flushing-itch-paresthesia-pain (SFIPP) Frey scale specifically designed by the authors themselves for this study. RESULTS Before BoNT-A injection, all patients (100%) complained gustatory sweating, 80% paresthesia, 77% gustatory flushing, 60% pain and 60% gustatory itch. The SFIPP-Frey overall score and the symptom-specific ones decreased significantly at each post-therapy control. CONCLUSIONS The prevalence of "unusual" manifestations is not negligible. BoNT-A improves symptoms severity. The SFIPP-Frey scale may be useful to assess symptoms and to monitor post-therapy outcomes.
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Affiliation(s)
- Maria Raffaella Marchese
- Division of Otorhinolaryngology, Department of Aging, Neuroscience, Orthopedics and Head and Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Bussu
- Division of Otolaryngology, Azienda Ospedaliero Universitaria di Sassari, Sassari, Italy.,Division of Otolaryngology, Università di Sassari, Sassari, Italy
| | - Stefano Settimi
- Division of Otorhinolaryngology, Department of Aging, Neuroscience, Orthopedics and Head and Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Emanuele Scarano
- Division of Otolaryngology, Azienda Ospedaliera Pia Fondazione di Culto e Religione Cardinale G. Panico, Tricase, Italy
| | - Giovanni Almadori
- Division of Otorhinolaryngology, Department of Aging, Neuroscience, Orthopedics and Head and Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Division of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jacopo Galli
- Division of Otorhinolaryngology, Department of Aging, Neuroscience, Orthopedics and Head and Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Division of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Rome, Italy
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26
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De Corso E, Mastrapasqua RF, Tricarico L, Settimi S, Di Cesare T, Mele DA, Trozzi L, Salonna G, Paludetti G, Galli J. Predisposing factors of rhinitis medicamentosa: what can influence drug discontinuation? Rhinology 2020; 58:233-240. [PMID: 31904029 DOI: 10.4193/rhin19.295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND the primary end point of our study was to define risk factors and identify the underlying conditions that may have led to the abuse of vasoconstrictors in rhinitis medicamentosa. Moreover, we analysed factors that may influence the vasoconstrictors discontinuation. METHODOLOGY this was a prospective case-control observational study. Cases and controls were evaluated at the baseline in order define factors that may have influenced onset of rhinitis medicamentosa. They were re-evaluated at 3 months to verify symptoms control and drug discontinuation. Finally, they underwent a phone call questionnaire after 12 months regarding drug discontinuation. A potential bias of our study is that evaluating discontinuation we included subjects treated differently according to the main diagnosis. RESULTS patients with rhinitis medicamentosa were more frequently smokers than controls, they had higher mean HAMA scores and positive psychiatric diseases history. Additionally, we frequently detected a local inflammation at nasal cytology in patients with rhinitis medicamentosa. A significant improvement in all nasal symptoms scores was observed in cases and controls but 29.4% of cases did not discontinue the vasoconstrictors. Two major factors negatively influenced discontinuation: positive nasal cytology and pathological HAMA score. CONCLUSION we observed that positive local inflammation, anxiety and smoking habit correlate positively with vasoconstrictors abuse. In addition, we demonstrated that anxiety and local inflammation were the most important factors impairing drug discontinuation.
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Affiliation(s)
- E De Corso
- "A. Gemelli" Hospital Foundation, IRCCS, Head and Neck Surgery Area, Institute of Otorhinolaryngology, Catholic University of the Sacred Heart. Rome, Italy
| | - R F Mastrapasqua
- "A. Gemelli" Hospital Foundation, IRCCS, Head and Neck Surgery Area, Institute of Otorhinolaryngology, Catholic University of the Sacred Heart. Rome, Italy
| | - L Tricarico
- "A. Gemelli" Hospital Foundation, IRCCS, Head and Neck Surgery Area, Institute of Otorhinolaryngology, Catholic University of the Sacred Heart. Rome, Italy
| | - S Settimi
- "A. Gemelli" Hospital Foundation, IRCCS, Head and Neck Surgery Area, Institute of Otorhinolaryngology, Catholic University of the Sacred Heart. Rome, Italy
| | - T Di Cesare
- "A. Gemelli" Hospital Foundation, IRCCS, Head and Neck Surgery Area, Institute of Otorhinolaryngology, Catholic University of the Sacred Heart. Rome, Italy
| | - D A Mele
- "A. Gemelli" Hospital Foundation, IRCCS, Head and Neck Surgery Area, Institute of Otorhinolaryngology, Catholic University of the Sacred Heart. Rome, Italy
| | - L Trozzi
- "A. Gemelli" Hospital Foundation, IRCCS, Head and Neck Surgery Area, Institute of Otorhinolaryngology, Catholic University of the Sacred Heart. Rome, Italy
| | - G Salonna
- "A. Gemelli" Hospital Foundation, IRCCS, Head and Neck Surgery Area, Institute of Otorhinolaryngology, Catholic University of the Sacred Heart. Rome, Italy
| | - G Paludetti
- "A. Gemelli" Hospital Foundation, IRCCS, Head and Neck Surgery Area, Institute of Otorhinolaryngology, Catholic University of the Sacred Heart. Rome, Italy
| | - J Galli
- "A. Gemelli" Hospital Foundation, IRCCS, Head and Neck Surgery Area, Institute of Otorhinolaryngology, Catholic University of the Sacred Heart. Rome, Italy
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Lucidi D, Paludetti G, Settimi S, De Corso E, Picciotti PM, Sergi B. How Long Is Otosclerosis Surgery Effective? Hearing Results after a 22-Year Follow-Up. Audiol Neurootol 2020; 26:121-126. [PMID: 32882686 DOI: 10.1159/000509106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 03/16/2020] [Accepted: 06/02/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Stapes surgery is a safe procedure, with favourable hearing outcome. The objective of the study is to assess the long-term hearing results, addressing the bone conduction (BC) decay and the need for hearing aids in otosclerosis patients. METHODS We enrolled patients who underwent stapes surgery by means of stapedectomy or stapedotomy between 1991 and 2001. All enrolled patients underwent pure-tone audiometry (PTA) between September 2017 and June 2018. A set of questions was administered to record the prevalence of subjective symptoms and the need for hearing aids. RESULTS Seventy patients were enrolled for a long-term evaluation; 37 patients underwent bilateral surgery; therefore, 107 ears were included in the analysis. The average follow-up period was 22 years. No statistically significant difference was found between early and late post-operative air conduction (AC) PTA (41 vs. 49 dB; p > 0.05) nor between early and late post-operative BC-PTA (29 vs. 37 dB; p > 0.05). A significant difference was observed for AC at 8 kHz (65 vs. 78 dB; p < 0.05) and BC at 2 and 4 kHz (28 vs. 40 dB and 45 vs. 58 dB, respectively; p < 0.05). CONCLUSIONS This is, to our knowledge, the longest mean follow-up time in the literature. A mild decrease in both AC and BC threshold can be expected and the sensorineural decay is more pronounced on the high frequencies. The subjective hearing symptoms and overall sound perception are satisfactory.
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Affiliation(s)
- Daniela Lucidi
- Head & Neck Department, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gaetano Paludetti
- Head & Neck Department, Università Cattolica del Sacro Cuore, Rome, Italy.,Otorhinolaryngology and Head & Neck Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Rome, Italy
| | - Stefano Settimi
- Head & Neck Department, Università Cattolica del Sacro Cuore, Rome, Italy,
| | - Eugenio De Corso
- Otorhinolaryngology and Head & Neck Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Rome, Italy
| | - Pasqualina Maria Picciotti
- Head & Neck Department, Università Cattolica del Sacro Cuore, Rome, Italy.,Otorhinolaryngology and Head & Neck Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Rome, Italy
| | - Bruno Sergi
- Head & Neck Department, Università Cattolica del Sacro Cuore, Rome, Italy.,Otorhinolaryngology and Head & Neck Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Rome, Italy
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28
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De Corso E, Settimi S, Tricarico L, Mele DA, Mastrapasqua RF, Di Cesare T, Salvati A, Trozzi L, De Vita C, Romanello M, Paludetti G, Galli J. Predictors of Disease Control After Endoscopic Sinus Surgery Plus Long-Term Local Corticosteroids in CRSwNP. Am J Rhinol Allergy 2020; 35:77-85. [PMID: 32564684 DOI: 10.1177/1945892420936196] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND in the era of new biological agents it is important to identify patients who may benefit from conventional therapies such as endoscopic sinus surgery (ESS) plus long-term local corticosteroids from those with patterns of inflammation that are more difficult to control post-operatively and who may benefit from other therapies. OBJECTIVE determine if preoperative assessment of type and grade of inflammation and clinical factors can predict disease control with ESS plus long-term local corticosteroids in chronic rhinosinusitis with nasal polyps (CRSwNP). METHODS Eighty patients treated with ESS plus mometasone-furoate 200 μg BID for CRSwNP and followed for at least 1 year were enrolled (November 2017-December 2018) in this prospective observational study. Type and grade of inflammation were evaluated preoperatively by nasal cytology. Based on cellular pattern, patients were grouped as neutrophilic (n = 20), eosinophilic (n = 38), or mixed eosinophil-neutrophilic (n = 22). SNOT-22 and Lund-Kennedy Endoscopic Score were evaluated at baseline and at 3, 6, 9, and 12 months after surgery and used to define disease control. RESULTS The cumulative probability of remaining free of significant modification of endoscopic score (Lund-Kennedy Endoscopic Score >2) at 3, 6, 9, and 12 months was 0.84, 0.76, 0.71, and 0.68, respectively. At 12-month postoperative evaluation good disease control was observed in 54 of 80 patients (67.5%). Compared to those with good post-operative disease control, those with poor control had a significantly higher pre-operative mean count of eosinophils and neutrophils (p < 0.05). The preoperative inflammatory pattern was associated with relative risk of poor control: neutrophilia (RR: 3.10; CI:1.24-7.71), eosinophilia (RR:8.42; CI:2.72-15.12), and mixed eosinophilic and neutrophilic (RR:25.11; CI:19.41-30.01). We also confirmed that asthma, allergy, blood eosinophilia, and ASA triad could predict poor control. CONCLUSIONS The type and load of inflammation evaluated preoperatively and selected clinical factors can predict poor control of CRSwNP treated with ESS and local corticosteroids.
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Affiliation(s)
- Eugenio De Corso
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Settimi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Laura Tricarico
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | | | - Antonio Salvati
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lucrezia Trozzi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carla De Vita
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Matteo Romanello
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gaetano Paludetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jacopo Galli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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Galli J, Settimi S, Tricarico L, Almadori G, Paludetti G. Clinical and surgical management of patients with head and neck cancer in a COVID-19 dedicated center in Italy. Head Neck 2020; 42:1466-1470. [PMID: 32476204 PMCID: PMC7300905 DOI: 10.1002/hed.26263] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction For the EARs NOSE AND THROAT (ENT) surgeon, there are many challenges that show‐up in the clinical management of a patient affected by a head and neck cancer during COVID‐19 pandemic, especially in the postoperative period. Methods During the acute COVID‐19 emergency phase in Italy, we analyzed the management of a patient affected by a head and neck cancer. We reported several clinical data about the hospitalization period, pointing out the difficulties encountered both from clinical and management point of view. Results During pandemic, we admitted 27 oncological patients at our ENT Department. Delays in surgical procedures, complications of hospitalizations, need for radiological studies, and possible transfer to other hospital ward, due to suspect SARS‐CoV‐2 infection, were registered. Conclusions The changes in the whole health care system during the COVID‐19 pandemic have impacted the management of patients with head and neck cancer, generating several clinical challenges for the ENT surgeon.
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Affiliation(s)
- Jacopo Galli
- Otorhinolaryngology and Head and Neck Surgery Unit, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy.,Head and Neck Department, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Settimi
- Head and Neck Department, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Laura Tricarico
- Head and Neck Department, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Almadori
- Otorhinolaryngology and Head and Neck Surgery Unit, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy.,Head and Neck Department, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gaetano Paludetti
- Otorhinolaryngology and Head and Neck Surgery Unit, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy.,Head and Neck Department, Università Cattolica del Sacro Cuore, Rome, Italy
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Galli J, Meucci D, Salonna G, Anzivino R, Giorgio V, Trozzi M, Settimi S, Tropiano ML, Paludetti G, Bottero S. Use OF NBI for the assessment of clinical signs of rhino-pharyngo-laryngeal reflux in pediatric age: Preliminary results. Int J Pediatr Otorhinolaryngol 2020; 128:109733. [PMID: 31670195 DOI: 10.1016/j.ijporl.2019.109733] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/11/2019] [Accepted: 10/12/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Laryngopharyngeal reflux (LPR) is a complex problem in pediatric population: diagnosis and clinical presentation are still controversial. Classic white light endoscopy shows some pathognomonic signs of LPR in children, such as thickening of pharyngo-laryngeal mucus, the cobblestoning aspect of pharyngeal mucosa, arytenoid edema/hyperemia, nodular thickening/true vocal cord edema, hypertrophy of the posterior commissure, subglottic edema. The NBI (Narrow Band Imaging) technology, generally used in oncology, allows to study neoangiogenesis and hypervascularization of the mucosa, common aspects in both chronic inflammation and neoplastic transformation. The aim of our study was to evaluate the added value of this technology in identifying the main laryngopharyngeal reflux sign in a pediatric population. METHODS We evaluated at the Otolaryngology Unit of the "Fondazione Policlinico A. Gemelli" hospital and the Airway Surgery Unit of the "Bambino Gesù" Children's Hospital 35 patients aged from 2 months to 16 years divided into two groups in the period between November 2017 and May 2018. Group A included patients with clinical suspicion of LPR after gastroenterologist evaluation and Group B included patients who underwent an endoscopic evaluation for the assessment of recurrent respiratory symptoms such as stridor, recurrent croup, wheezing and persistent cough. We performed an endoscopic evaluation by white light and NBI for each patient, comparing the results of both methods to evaluate signs of pharyngo-laryngeal reflux and to calculate the value of reflux finding score (RFS). RESULTS The analysis of the data showed: for Group A an average value of RFS with white light of 11,84 (range 8-17, standard deviation 2,52 ± 0,57) and with NBI of 13,63 (range 10-17, standard deviation 2,13 ± 0,49); for Group B the analysis of the data showed an average value of RFS with white light of 10,06 (range 8-14, standard deviation 2,32 ± 0,58) and with NBI of 12,50 (range 9-18, standard deviation 2,63 ± 0,65). The comparison between the two methods resulted significant. Furthermore evaluation by NBI allowed to highlight other signs of pharyngo-laryngeal reflux, characteristic of pediatric age and not included in RFS, in particular cobblestone aspect of the hypopharingeal mucosa, phlogosis of the tonsillar crypts and adenoid surface, hyperemia and hypervascularization of subglottic and tracheal mucosa. CONCLUSION Although still preliminary our results represent an interesting starting point for further studies, because they underline the potentiality of NBI endoscopy in LPR evaluation and how this technology could improve the identification of reflux signs.
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Affiliation(s)
- J Galli
- Department of Head and Neck Surgery - Institute of Otorhinolaryngology, Catholic University School of Medicine and Surgery, Rome, Italy
| | - D Meucci
- Airway Surgery Unit, Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy.
| | - G Salonna
- Department of Head and Neck Surgery - Institute of Otorhinolaryngology, Catholic University School of Medicine and Surgery, Rome, Italy
| | - R Anzivino
- Airway Surgery Unit, Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - V Giorgio
- Department of Pediatrics, Catholic University School of Medicine and Surgery, Rome, Italy
| | - M Trozzi
- Airway Surgery Unit, Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - S Settimi
- Department of Head and Neck Surgery - Institute of Otorhinolaryngology, Catholic University School of Medicine and Surgery, Rome, Italy
| | - M L Tropiano
- Airway Surgery Unit, Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - G Paludetti
- Department of Head and Neck Surgery - Institute of Otorhinolaryngology, Catholic University School of Medicine and Surgery, Rome, Italy
| | - S Bottero
- Airway Surgery Unit, Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy
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Galli J, Settimi S, Salonna G, Mele DA, De Corso E, Paludetti G. Narrow Band Imaging for lingual tonsil hypertrophy and inflammation, in laryngo-pharyngeal reflux disease. Eur Arch Otorhinolaryngol 2019; 277:819-825. [PMID: 31858222 DOI: 10.1007/s00405-019-05765-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 09/07/2019] [Accepted: 12/09/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE The objective of this study is to analyse the relationship between the endoscopic signs of laryngo-pharyngeal reflux, the lingual tonsil hypertrophy (LTH) and its inflammation, adopting Narrow Band Imaging (NBI) technology. METHODS We enrolled, as cases, patients with clinical diagnosis of laryngopharyngeal reflux disease (LPRD), a Reflux Symptom Index (RSI) ≥ 13, and a Reflux Finding Score (RFS) ≥ 7. Controls were enrolled among patients who underwent the same transnasal endoscopy, equipped with NBI, with a RSI < 13 and a RFS < 7. Nasopharynx, Lingual Tonsils (LT), Hypopharynx and Larynx were evaluated by two experienced otolaryngologists, who calculated the Reflux Finding Scale (RFS) score and focused their attention on the base of the tongue, observing its surface with NBI technology. RESULTS 82 patients with diagnosis of laryngopharyngeal reflux were enrolled as cases. Mean RFS was 11.7 (SD = 2.9). As controls, we enrolled 80 patients. Mean RFS was 2.7 (SD = 1.63). We found that RFS positivity was associated with a significant increase in LT dimension (2.5 vs 1.1, p < 0.001), with a higher LT crypt inflammation grading (1.8 vs 0.09, p < 0.001) and with a higher Roman Cobblestone pattern grading (1.48 vs 0.11, p < 0.001). A significant correlation between the crypt inflammation and the hyperemia subscore of RFS was present (r = 0.696, p < 0.0001), while it was not possible to find a correlation between crypt inflammation and either diffuse laryngeal edema (r = 0.166, p = 0.135) and posterior commissure hypertrophy (r = 0.089, p = 0.427). CONCLUSIONS NBI allowed us to identify endoscopically the presence of enlarged lingual tonsil, crypt inflammation and superficial mucosal changes, in patients affected by LPRD. LEVEL OF EVIDENCE 2 (prospective, case-control study).
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Affiliation(s)
- Jacopo Galli
- Institute of Otolaryngology, Head and Neck Surgery, School of Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Stefano Settimi
- Institute of Otolaryngology, Head and Neck Surgery, School of Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy.
| | - Giampiero Salonna
- Institute of Otolaryngology, Head and Neck Surgery, School of Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Dario Antonio Mele
- Institute of Otolaryngology, Head and Neck Surgery, School of Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Eugenio De Corso
- Institute of Otolaryngology, Head and Neck Surgery, Fondazione Policlinico Universitario "A.Gemelli" - IRCCS, Rome, Italy
| | - Gaetano Paludetti
- Institute of Otolaryngology, Head and Neck Surgery, School of Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
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Almadori G, De Corso E, Visconti G, Almadori A, Di Cintio G, Mele DA, Settimi S, Paludetti G, Salgarello M. Impact of internal mammary artery perforator propeller flap in neck resurfacing and fistula closure after salvage larynx cancer surgery: Our experience. Head Neck 2019; 41:3788-3797. [PMID: 31397524 DOI: 10.1002/hed.25903] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/27/2019] [Accepted: 07/22/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Salvage total laryngectomy (TL) and laryngopharyngectomy (LP) after chemoradiotherapy may produce disfiguring defects with severe complications that require complex reconstructions. METHODS Between January 2012 and December 2018, we enrolled 25 patients who underwent internal mammary artery perforator (IMAP) flap reconstruction after salvage TL or LP. We performed retrospective review of clinical charts to collect information such as history, timing of reconstruction, type of defect, follow-up, donor and recipient site complications, and overall flap survival (OFS) rate. Three years overall survival (OS), relapse-free survival (RFS), and disease-specific survival (DSS) were calculated. RESULTS The OFS rate was 95%. One partial flap necrosis was recorded. No donor-site complications were found. The mean follow-up was 18 months. Three years OS was 44%, RFS was 47%, and DSS was 54%. CONCLUSIONS IMAP flap appears to be safe, versatile, and easy to harvest, with minimal donor site morbidity. It is a reliable option in Head&Neck reconstruction, in salvage surgery as well.
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Affiliation(s)
- Giovanni Almadori
- Cervico-Facial Oncological Surgery Unit, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Eugenio De Corso
- Otorhinolaryngology, Head and Neck Surgery, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Visconti
- Plastic and Reconstructive Surgery, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Aurora Almadori
- Plastic and Reconstructive Surgery, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Di Cintio
- Otorhinolaryngology, Head and Neck Surgery, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Dario A Mele
- Otorhinolaryngology, Head and Neck Surgery, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Stefano Settimi
- Otorhinolaryngology, Head and Neck Surgery, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Gaetano Paludetti
- Otorhinolaryngology, Head and Neck Surgery, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Marzia Salgarello
- Plastic and Reconstructive Surgery, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
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De Corso E, Anzivino R, Galli J, Baroni S, Di Nardo W, De Vita C, Salvati A, Autilio C, Settimi S, Mele D, Paludetti G, Mullol J. Antileukotrienes improve naso-ocular symptoms and biomarkers in patients with NARES and asthma. Laryngoscope 2018; 129:551-557. [PMID: 30478909 DOI: 10.1002/lary.27576] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/09/2018] [Accepted: 08/24/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of our study was to analyze the montelukast effectiveness in improving oculonasal symptoms, patient-reported outcomes (PROs), and eosinophilic biomarkers in patients with nonallergic rhinitis eosinophilic syndrome (NARES). METHODS We enrolled prospectively 80 symptomatic patients treated with 10 mg once a day of montelukast in monotherapy for 2 months. All patients were investigated before and after treatment. Nasal symptoms (nasal obstruction, rhinorrhoea, sneezing, nasal itching), ocular symptoms (redness/puffiness, watery eyes), and other PROs (olfactory dysfunction, difficulty going to sleep, nighttime awakenings, and nasal congestion on awakening) were scored by visual analogic scale. The following clinical scores were assessed: Total Nasal Symptom Score (T4NSS), Total Ocular Symptom Score (T2OSS), Total Symptom Score of Patient-Reported Outcomes (TSS-PROs), and a Composite Symptoms Score (CSS). Patients were classified as responders when a reduction of at least 50% of the CSS was observed. Before and after treatment, the eosinophilic biomarkers in nasal lavage were analyzed: nasal eosinophilia (number of eosinophils per high power field), eotaxin-1 and eotaxin-2. RESULTS After treatment, significant reductions were observed for all the symptom scores. Forty-two of 78 patients were considered responders. A significant reduction of eosinophils in nasal mucosa and of levels of eotaxin-1 and eotaxin-2 in nasal lavage were observed after treatment in responder patients. Patients with asthma had an increased probability to be responders. CONCLUSION NARES patients may benefit from treatment with montelukast. In particular, the presence of concomitant asthma may be predictive of a greater efficacy. LEVEL OF EVIDENCE 2 Laryngoscope, 129:551-557, 2019.
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Affiliation(s)
- Eugenio De Corso
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Otorinolaringoiatria, Dipartimento Scienze dell'Invecchiamento Neurolgiche e della Testa e del Collo, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Roberta Anzivino
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Otorinolaringoiatria, Dipartimento Scienze dell'Invecchiamento Neurolgiche e della Testa e del Collo, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jacopo Galli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Otorinolaringoiatria, Dipartimento Scienze dell'Invecchiamento Neurolgiche e della Testa e del Collo, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Silvia Baroni
- Department of Diagnostic and Laboratory Medicine-Institute of Biochemistry and Clinical Biochemistry
| | - Walter Di Nardo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Otorinolaringoiatria, Dipartimento Scienze dell'Invecchiamento Neurolgiche e della Testa e del Collo, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carla De Vita
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Otorinolaringoiatria, Dipartimento Scienze dell'Invecchiamento Neurolgiche e della Testa e del Collo, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Salvati
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Otorinolaringoiatria, Dipartimento Scienze dell'Invecchiamento Neurolgiche e della Testa e del Collo, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Chiara Autilio
- Department of Biochemistry, Faculty of Biology and Research Institute Hospital 12 the Octubre, Complutense University, Madrid, Spain
| | - Stefano Settimi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Otorinolaringoiatria, Dipartimento Scienze dell'Invecchiamento Neurolgiche e della Testa e del Collo, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Dario Mele
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Otorinolaringoiatria, Dipartimento Scienze dell'Invecchiamento Neurolgiche e della Testa e del Collo, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gaetano Paludetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Otorinolaringoiatria, Dipartimento Scienze dell'Invecchiamento Neurolgiche e della Testa e del Collo, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, Department of Otorhinolaryngology, Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBERES Barcelona, Catalonia, Spain
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