SUMMARYObjectiveThe prognostic significance of the resection margins is still subject of conflicting opinions. The purpose of this paper is to report the results of a study on the margins in carcinoma of the oral cavity, oro-hypopharynx and larynx.MethodsA multicentre prospective study was carried out between 2015 and 2018 with the participation of 10 Italian reference hospitals. The primary objective was to evaluate local control in patients with well-defined clinical characteristics and comprehensive histopathological information.ResultsDuring the study period, 455 patients were enrolled; the minimum follow-up was 2 years. Previous treatment, grading and fresh specimen examination were identified as risk factors for local control in multivariate analysis. On the basis of these results, it seems possible to delineate “risk profiles” for different oncological outcomes.DiscussionThe prognostic significance of the margins is reduced, and other risk factors emerge, which require diversified treatment and follow-up.ConclusionsMultidisciplinary treatment with adjuvant therapy, if indicated, reduces the prognostic importance of margins. Collaboration with a pathologist is an additional favourable prognostic factor and quality indicator.An appendix with literature review is present in the online version.

SUMMARYCoronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is characterised by a wide spectrum of disease severity ranging from asymptomatic or oligosymptomatic cases to severe and life-threatening forms. As this new coronavirus is a respiratory virus, it is not surprising that many symptoms caused by SARS-CoV-2 infection are related to the involvement of the upper respiratory tract. In addition the most pathognomonic of symptoms, i.e. the alteration of smell, nasal obstruction, sore throat and cough have been consistently described as early symptoms of the disease. However, for other ENT symptoms, such as oral lesions and audio-vestibular changes, a causal relation is far from proven. The rapid and extensive spread of COVID-19 makes it difficult to demonstrate a causative link between several ENT symptoms and SARS-CoV-2 infection and it is reasonable to assume that at least in some cases this link is actually coincidental in some cases. Moreover, following the phenomenon of the race to publish, there has been an uncontrolled release of poor-quality articles showing the most disparate associations mainly based on a temporal association between SARS-CoV-2 infection and symptoms of various types including those of the ENT area. In this narrative review of the literature, we will critically describe the ENT symptoms of COVID-19.

SUMMARYObjectivesTo investigate the long-term effects of cochlear implants as a treatment for patients with severe to profound neurosensory loss associated with severe tinnitus.MethodsProspective study in 17 adult patients with severe to profound sensorineural hearing loss associated with severe tinnitus, indicated with a Tinnitus Handicap Inventory (THI) score ≥ 58%, and hyperacusis. Measures were made on hearing, tinnitus, hyperacusis and quality of life up to 5 years after activation of the sound processor of the cochlear implant. It was evaluated by using the disyllabic test, THI, visual analogue scale and Glasgow Benefit Inventory questionnaire.Results60 months after cochlear implantation, improvements in loudness and discomfort of tinnitus, speech discrimination and hyperacusis were observed. Subjects perceive an important subjective benefit upon receiving the cochlear implant.ConclusionsCochlear implants can be used as treatment for patients with severe to profound sensorineural hearing loss associated with severe tinnitus and hyperacusis with long-term benefits on quality of life and lasting relief of tinnitus.

SUMMARYObjectiveThis study compared three severity measures for chronic rhinosinusitis with nasal polyps (CRSwNP). The outcome was to identify patients who are eligible for biological therapy.Methods330 adult patients with CRSwNP were examined. Nasal polyp score (NPS), sinonasal outcome test (SNOT-22) and clinical-cytological grading (CCG) were compared. Clinical history, past surgery and asthma control test were also considered.ResultsOnly 45 (13.6%) patients had a contextual positivity to the three severity measures. The concordance among tests was slight/fair. Patients with severe disease (all tests positive) had more impaired parameters. The mixed cytotype (OR = 4.07), nasal obstruction (OR = 10.06), post-nasal drip (OR = 1.98), embarrassment (OR = 2.53) and difficulty falling asleep (OR = 1.92) were significantly associated with severe CRSwNP.ConclusionsTo identify candidates for biological therapy, the contextual use of NPS, SNOT-22 and CCG is preferable. In this way, global assessment of CRSwNP, including morphology, inflammation, comorbidity, symptoms and quality of life is possible.

SUMMARYChronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous inflammatory condition of nasal mucosa and paranasal sinuses, predominantly mediated by type 2 inflammation and often associated with comorbid asthma and/or Exacerbated Respiratory Disease (N-ERD). The standard of care involves local and systemic corticosteroids and/or sinonasal surgery, although these options may be associated with recurrences and patients may require revision surgery. Difficult-to-treat patients, in fact, have a more severe disease requiring high systemic corticosteroid use and/or multiple sinonasal surgeries. Literature data suggests that biologic agents targeting specific key effectors of type 2 inflammation may offer supplemental therapy for patients with severe and uncontrolled CRSwNP, leading to significant improvement in several outcomes. For these reasons, over the years the endotyping of the disease has become increasingly important. Herein, we provide not only an update on the existing studies about the most promising biologics in CRSwNP, but also critical discussion on controversies about the use of biologics in severe uncontrolled CRSwNP. We finally provide consensus on strategic issues gathered among experts of the Joint Committee of Italian Society of Otorhinolaryngology on biologics in order to offer the best care for difficult to treat patients.

SUMMARYObjectiveThe aim of our study was to investigate the presence of dysphagia in patientswith Obstructive Sleep Apnoea (OSA) and to correlate swallowing impairmentwith hypnologic and anatomic parameters.MethodsThe study population includes 36 patients suffering from OSA. Patients weredivided into two groups using the presence of dysphagia as a distinctiveparameter. Group 1 included 27 OSA patients without signs of dysphagia andGroup 2 included 9 OSA patients with signs of dysphagia.ResultsThe age of patients in Group 2 was higher compared with the age of patientsin Group 1. Analysis of Continuous Positive Airway Pressure (CPAP), obtainedin the titration phase, showed that OSA patients with signs of dysphagiarequired a higher level of CPAP pressure than those who were not affected byswallowing abnormalities (12.6 ± 1 vs 10.5 ±1.9 p = 0.003). No other differences in anthropometric, hypnologic, orarterial blood gas values were found between the two groups.ConclusionsIn clinical practice, all OSA patients should undergo a complete ENT exam,including assessment of swallowing, before CPAP therapy is started. This maypredict the need for higher CPAP pressure settings to resolve apnoeaepisodes in the presence of dysphagia as well as guide the choice of CPAPinterfaces (orofacial vs. nasal) in these patients.

SUMMARYObjectivePositional Obstructive Sleep Apnoea Syndrome (POSAS) is a sub-type of Obstructive Sleep Apnoea Syndrome (OSAS) in which obstructive apnoeas occur mainly in the supine sleeping position. In clinical practice, information on sleep posture is generally gathered by polysomnographic exam (PSG). The current trend in positional therapies consists of position trainers which help to avoid the supine position. The aim of this study is to detect the reliability of different devices on assessing sleeping position, comparing the data with objective evaluation by an infra-red camera.MethodsWe compared the positional results of 4 healthy volunteers obtained from a type III PSG and with a neck-worn sleep position trainer (Night Shift - NS).ResultsData showed that NS is a good tool to assess the position of the trunk, with high rate of agreement with PSG, but in some conditions there are limitations, especially in detecting the real head and neck position and low accordance between NS data and information recorded by infra-red camera.ConclusionsOur study confirmed that more information about body position during sleep is needed, underling the necessity of developing new technologies that are able to better identify reciprocal body positions.

SUMMARYObjectiveOral lichen planus (OLP) is a chronic inflammatory disease. There are no markers that can be used to identify the risk of a malignant transformation of OLP to oral squamous cell carcinoma (OSCC).MethodsImmunohistochemical staining was performed among 56 patients with OLP and 66 patients with OSCC for p53, HSP90 and E-cadherin expression and presence of HPV16/18.ResultsSignificant differences in p53 and HSP90 expression between OLP and OSCC were found (p = 0.01 and p = 0.006, respectively). A positive correlation between HSP90 and p53 expression was seen in OLP (p = 0.017). Univariate analysis identified HSP90 expression and HPV16/18 presence as prognostic factors for overall survival time (OS) (p < 0.05). In multivariate analysis, only HSP90 expression was an independent prediction factor for shorter OS of OSCC patients (p = 0.016).ConclusionsThe present study suggests that cooperation between p53 and HSP90 as well as between HPV16/18 and HSP90 exists in OLP and may affect the biological behaviour of OLP. The observed expression of HSP90 and p53 in OLP and their increase in OSCC suggests that these proteins participate in the malignant transformation of OLP. HSP90 may be a potential independent prognostic biomarker that can predict poor prognosis in OSCC.

SUMMARYObjectiveWe determined the influence of gastro-oesophageal reflux disease (GERD) on quality of life (QOL) before and after functional-endoscopic-sinus-surgery (FESS) for chronic rhinosinusitis (CRS).MethodsMedically-recalcitrant CRS patients were recruited prior to FESS. GERD was diagnosed endoscopically. QOL was compared between patients with vs without GERD at baseline and one-year post-FESS.ResultsOf 187 CRS patients receiving FESS, 40 had GERD. Pre-operative QOL was significantly worse in CRS patients with vs without GERD. Pre-operative GERD health-related QOL (GERD-HRQL) and reflux symptom index (RSI) scores were both correlated with pre-operative SNOT-22 scores. Compared with non-GERD CRS patients, GERD patients demonstrated larger SNOT-22 improvements after FESS, such that post-operative SNOT-22 values were no longer significantly different between GERD and non-GERD groups. However, post-FESS, in patients with CRS without nasal polyps (unlike those with nasal polyps), the GERD (vs non-GERD) group suffered from greater sleep dysfunction and otologic/facial symptoms.ConclusionsCompared to CRS patients without GERD, those with GERD experienced poorer pre-operative QOL and greater QOL improvement after FESS.

SUMMARYObjectiveTo evaluate the olfactory function in primary Sjögren’s syndrome (pSS) patients and investigate its correlation with dry eye parameters.MethodsThirty-eight pSS patients (49.47 ± 10.06 years) and 20 healthy volunteers (47.40 ± 8.92 years) were enrolled in the study. All participants underwent ENT and eye examinations including a modified Connecticut Chemosensory Clinical Research Center (CCCRC) test, tear break-up time (TBUT), ocular surface staining (OSS) and Schirmer test. The parameters were compared between the two groups using Student-t test, and Pearson test was used to evaluate the correlations.ResultsMean Schirmer and TBUT values were 2.39 ± 1.48 mm/5 min and 3.66 ± 1.5 sec in pSS and 18.30 ± 6.16 mm/5 min and 14.60 ± 3.64 sec in healthy subjects (p < 0.001, both). There was a significant decrease in mean odour threshold, odour identification, CCCRC and VAS scores in the pSS group (p < 0.001). Dry eye parameters showed moderate correlations with CCCRC parameters (r = 0.4-0.6, p < 0.001) and olfaction VAS score (r = 0.4-0.75, p < 0.05).ConclusionsThere is a mild clinical impairment in smell sense in patients with pSS which seems to be correlated with dry eye parameters. Therefore, smell complaints should be queried in pSS patients suffering from severe dry eye.