ACTA Otorhinolaryngologica Italica

Modular approach to the parapharyngeal space based on transoral robotic surgery

2025-10-08T17:32:29+00:00

Objective. Lesions of the parapharyngeal space can be resected through a variety of approaches, depending on their location and biology, as well as on the surgeon’s experience. Historically, the transcervical approach has been the most employed, while the transoral has been neglected because of its intrinsic limitations. The advent of robotic surgery has expanded the indications of transoral resection thanks to its reduced morbidity and the possibility of combination with other accesses.
Methods. We conducted a retrospective analysis of patients submitted to transoral robotic surgery (TORS) for parapharyngeal lesions at the European Institute of Oncology. We further focused on patients treated with a combined transoral-transcervical approach.
Results. Between 2013 and 2024, 43 patients underwent TORS for a parapharyngeal lesion, with curative intent in the majority of cases (93%). In 9 cases (19%), a transcervical/transparotid approach was combined with TORS. A transmandibular approach was never necessary. The postoperative course was uneventful for all patients. The majority of lesions were benign (79%).
Conclusions. TORS has proven to be a viable option for lesions of the parapharyngeal space. A combined modular approach is feasible to lessen surgical morbidity.

A hidden diagnosis in the tonsil: recognising and differentiating intratonsillar abscess

2025-07-17T05:35:35+00:00

Objective. Peritonsillar abscess (PTA) and intratonsillar abscess (ITA) are distinct entities, but the latter is often overlooked due to its rarity and diagnostic difficulty. This study compares their clinical, laboratory, and microbiological profiles to identify distinguishing features.
Methods. This single-centre retrospective study included 367 patients diagnosed with PTA (n = 311) or ITA (n = 56) between 2019 and 2025. Demographics, symptoms, laboratory markers (e.g., white blood cells [WBC], neutrophils, lymphocytes, large unstained cells [LUC], C-reactive protein, sodium, neutrophil-to-lymphocyte ratio, systemic immune-inflammation index, and platelet-to-WBC ratio [PWR]), culture results, imaging, drainage outcomes, and hospital stay were analysed comparatively.
Results. PTA cases showed significantly higher WBC, neutrophil counts, and drainage volumes, with 80.8% drainage success versus 19.1% in ITA (p < 0.001). LUC and PWR were significantly elevated in ITA, suggesting a lymphocyte-dominant response. Fever was more frequent in ITA, while trismus and local spread were more characteristic of PTA.
Conclusions. ITA typically presents with smaller abscesses and limited systemic involvement, often responding to conservative treatment. Recognising ITA as a distinct clinical entity may improve diagnosis and management strategies.

Italian validation of the ENS6Q: a disease-specific questionnaire for empty nose syndrome

2026-02-23T17:35:58+00:00

Side correlation between subjective visual vertical tilt and symptoms in migraine with vertigo

2025-10-26T14:56:03+00:00

Objective. To analyse the subjective visual vertical (SVV) in migraine patients with balance disorders and its correlation with symptoms. We hypothesise that vestibular imbalance reflects a global migraine activation leading to symptom prevalence on one side.
Methods. Twenty-six migraine patients with vertigo and/or dizziness (Group A) were studied in the interictal period. Symptoms assessed: unilateral (U) vs bilateral (B) headache (H), cranial autonomic (CAS) or cochlear symptoms (CS), vertigo/dizziness. SVV test was performed in all participants. Group A was compared to Group B (migraine without vertigo/dizziness) and Group C (controls). Main parameters: SVV0 (mean tilt in 6 trials) and SVV side exclusivity (SE: tilt of same sign in ≥ 5 trials).
Results. SVV0A (0.80 ± 0.68) was significantly greater than SVV0B (0.39 ± 0.40; p = 0.01) and SVV0C (0.32 ± 0.19; p = 0.001). SVV SE was found in 78.6% of patients with vertigo and 18.7% with dizziness (p = 0.003). SVV SE incidence was higher in UH (64.7%) vs BH (11.1%; p = 0.02), and in UCAS (72.7%) and UCS (85.7%) vs BCAS/none (26.6%) and BCS/none (31.6%) (p = 0.02; p = 0.04).
Conclusions. A slight SVV tilt persists between vertigo attacks and correlates with migraine imbalance underlying side-prevalent symptoms.

The effect of aryepiglottic fold release as an adjuvant step in surgery for Type I laryngomalacia

2025-08-20T06:21:49+00:00

Objective. This study aims to evaluate the efficacy of unilateral aryepiglottic fold release as an adjunctive surgical step in the management of Type I laryngomalacia.
Methods. This study was prospectively conducted on a sample of paediatric patients with laryngomalacia. Our patients were randomly divided into Group A (study group, n = 25), undergoing adjuvant aryepiglottic fold release (AEFR), and Group B (control group, n = 25), who did not undergo adjuvant AEFR. Demographic data, clinical features, and outcome measures were compared between groups.
Results. A highly significant difference was observed in the time to resolution of postoperative stridor, with the study group demonstrating markedly earlier symptom resolution compared to the control group. Furthermore, the percentage change in oxygen saturation in both states was also significantly greater in the study group, reflecting a highly significant intergroup difference. Additionally, the incidence of perioperative respiratory adverse events (PRAEs) was significantly lower in the study group than in the control group.
Conclusions. Unilateral AEFR, as an adjunctive procedure, marks a significant advancement in management of Type I laryngomalacia. It offers targeted improvement in oxygen saturation levels during both wakefulness and sleep. Furthermore, the technique has been shown to decrease the incidence of PRAEs, delivering significant clinical and operational benefits.

Development of depression in patients with oropharyngeal cancer: a systematic review

2025-05-20T05:35:37+00:00

Objective. The incidence of oropharyngeal cancer (OPC) has increased in the Western world. OPC affects quality of life, although the risk of depression in patients with OPC remains unknown. We investigated the risk of developing depression in patients with OPC.
Methods. Studies were identified through a systematic search in PubMed and EMBASE following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Results. Four studies comprising 3,736 OPC patients (range, 130-2,497 patients) from the United States (US/SEER and US/Texas), Australia, and the United Kingdom (UK) were included. The studies differed in methodology. The UK study showed that 47% of OPC patients had depressive symptoms compared to 14% of OPC patients with mild, moderate, or severe depression in the Australian study at 12 months after diagnosis. The US/SEER study found a cumulative probability of 19% for developing depression within 5 years after diagnosis, while the US/Texas study found that 15% of the OPC patients had symptoms of major depression after OPC diagnosis but before radiotherapy.
Conclusions. Overall, this study indicates that OPC patients are at risk of developing depression, although studies are heterogenous. Screening for depression among OPC patients should be considered in future treatment regimens.

Traumatic lesions of the cervical trachea: conservative or surgical treatment? A systematic review

2025-07-27T16:37:06+00:00

Traumatic lesions of the cervical trachea are rare but critical conditions potentially resulting either from blunt, penetrating, or iatrogenic injuries. These traumatic events pose challenges in airway management due to their life-threatening nature and need for rapid decision-making. Choice of treatment – conservative versus surgical – depends on injury dynamics, features of the traumatic lesion, and patient-related factors. This systematic review, conducted following PRISMA guidelines on 211 studies involving 509 patients, evaluates management strategies, focusing on indications for conservative versus surgical approaches and differences between adults and children. Surgical treatment was preferred for penetrating and severe blunt traumas, while conservative management, such as distal intubation, was used for small, superficial lesions. Surgical indications included tears > 20 mm, significant subcutaneous emphysema, and ventilation failure. Treatment should be individualised based on lesion characteristics and patient factors. Surgery remains essential for severe cases, while conservative approaches are viable in selected scenarios, especially in children.

Cross-cultural adaptation of the Italian Chronic Rhinosinusitis Patient-Reported Outcome. Questionnaire

2025-11-14T08:17:44+00:00

Objective. The Chronic Rhinosinusitis Patient-Reported Outcome (CRS-PRO) is a validated 12- item tool for assessing symptom burden in chronic rhinosinusitis (CRS). Although cross-culturally validated in other languages, there is no Italian version. This study aimed to translate, adapt, and validate the CRS-PRO for Italian-speaking patients.
Methods. We conducted a prospective multicentre study in 5 Italian otolaryngology centres (Jan 2024 - Aug 2025). Translation and adaptation followed International Society for Pharmacoeconomics and Outcomes Research guidelines. Participants were adults with CRS without polyps (CRSsNP), with polyps (CRSwNP), and healthy controls. Psychometric testing included internal consistency (Cronbach’s α, McDonald’s ω), test-retest reliability (Intraclass Correlation Coefficient, ICC), Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) factor analyses, and construct validity.
Results. A total of 118 participants were enrolled (controls = 32, CRSsNP = 40, CRSwNP = 46). Internal consistency was moderate (Cronbach’s α = 0.669) but excellent (McDonald’s ω = 0.946). Reliability was high (ICC = 0.92). EFA supported a two-factor solution (physical, psychological), explaining 73.4% of the total variance. CFA confirmed this model (CFI = 0.978, TLI = 0.972, SRMR = 0.109), with strong interfactor correlation (r = 0.93). CRSwNP patients reported the highest burden.
Conclusions. The Italian CRS-PRO showed strong reliability, validity, and factorial structure, supporting its clinical and research use.

A novel approach to hearing amplification: audiometric outcomes from Nuance Audio over-the-counter hearing aid glasses

2025-10-06T13:54:05+00:00

Objective. To evaluate the first audiometric outcomes of Nuance Audio hearing glasses, an overthe- counter solution integrating air conduction amplification technology into standard eyeglass frames, in individuals with mild to moderate hearing loss.
Methods. Thirty-two adults (mean age 74 years) with symmetric, age-related mild to moderate sensorineural hearing loss were tested. Pure-tone and speech audiometry were performed under unaided and aided free-field conditions. Device settings were adjusted via smartphone app based on audiometric profiles and user preference. Paired t-tests assessed the differences.
Results. Nuance Audio glasses significantly improved hearing thresholds, especially at 4000-6000 Hz, with mean gains of 10-11 dB HL. Speech reception thresholds improved by 7 dB at 50% intelligibility and 6 dB at 100%. Amplification profile preferences matched audiometric slopes and no differences in benefit were found between mild and moderate hearing loss groups.
Conclusions. Nuance Audio glasses provide clinically relevant improvements in pure-tone and speech thresholds for adults with mild to moderate presbycusis. Their discreet, open-ear design and self-fitting approach address barriers to traditional hearing aids and may support earlier adoption.

Italian translation, cross-cultural adaptation and validation of the Mayo Clinic Vestibular Schwannoma Quality of Life (VSQOL) Index

2025-12-05T08:41:13+00:00

Background. The Mayo Clinic Vestibular Schwannoma Quality of Life (VSQOL) Index is a diseasespecific instrument for assessing health-related quality of life (HRQoL) in patients with sporadic vestibular schwannoma (VS). To date, there is no validated Italian version of this questionnaire. Objectives. This study aimed to translate, culturally adapt, and validate the VSQOL Index Version 2 in Italian (Italian VSQOL Index) while assessing its psychometric properties.
Methods. The VSQOL Index Version 2 was translated and culturally adapted according to the Functional Assessment of Chronic Illness Therapy (FACIT) methodology. A cohort of 39 Italian-speaking VS patients completed the Italian VSQOL Index alongside the Penn Acoustic Neuroma Quality of Life (PANQOL) Scale, the 36-Item Short Form Health Survey (SF-36), and the 21-Item Depression, Anxiety, and Stress Scale (DASS-21). Internal consistency (Cronbach’s α), test-retest reliability (intraclass correlation coefficient, ICC), and construct validity were analysed.
Results. The Italian VSQOL Index demonstrated excellent internal consistency, with Cronbach’s α ranging from 0.89 to 0.95 across its domains, and high test-retest reliability, indicated by an ICC ranging from 0.78 to 0.92 among the domains. Significant correlations with PANQOL, SF-36, and DASS-21 scores confirmed convergent validity. Patients received the questionnaire positively, with no major comprehension issues reported during cognitive debriefing.
Conclusions. The Italian VSQOL Index is a valid and reliable instrument for assessing HRQoL in Italian-speaking VS patients. Its application in clinical practice and research will enhance the evaluation of disease impact and treatment outcomes within this population.