ACTA Otorhinolaryngologica Italica

Ecchordosis physaliphora of the clivus: a case series and narrative review of the literature

Panagiotis Pyrgakis — 2025-09-23

Background. Ecchordosis physaliphora (EP) is a benign hamartomatous lesion, most commonly found in a retroclival position, as an incidental radiological finding. EP may become symptomatic, by creating a clival defect, leading to CSF leak and meningitis, thus requiring surgical treatment.
Methods. Retrospective case series.
Results. We present 5 cases of retroclival EP (4 males, 1 female; age range, 34-81 years) presenting in our department over the last 6 years. Four patients presented with CSF leak; 3 also had a history of bacterial meningitis, while one was diagnosed with meningitis on presentation. One patient was and remains asymptomatic 28 months later with the lesion being an incidental finding.
The EP was treated in all 4 symptomatic patients with removal of the lesion and reconstruction of the defect with an endoscopic endonasal transclival approach (EETTA). All 4 patients remain free of symptoms while the lesion has not recurred for 81, 72, 52, and 22 months, respectively.
Conclusions. A review of the literature depicts that there is a shift from transcranial approaches to the EETTA for treating retroclival EP. The present case series highlights that EETTA facilitates the complete excision of EP lesions, as well the reconstruction of the resulting defects, with minimal morbidity and hospitalisation.

The Host-index in patients undergoing upfront surgery and free flap reconstruction for head and neck squamous cell carcinoma

Valentina Cristofaro — 2025-09-23

Objective. The Host-index (H-index) is a value obtained using blood laboratory parameters. Elevated H-index is a negative prognostic factor in patients with head and neck squamous cell carcinoma (HNSCC). The purpose of our study was to assess the prognostic impact of the H-Index in patients with locally advanced tumours who underwent reconstructive surgery with free flaps.
Methods. We performed a retrospective study on a cohort of patients referred to our center from January 2013 to October 2018. We assessed the prognostic role of H-index in terms of disease-free (DFS) and overall survival (OS).
Results. A total of 99 patients were studied, with a median age of 66 years. After a median follow-up of 46.5 months (range, 1.4-121.9), 5-year OS was 59.6% (CI 29.3-57.5) and 5-year DFS 47.5% (CI 16.7-49.2). The H-index showed a statistically significant correlation with a shorter DFS (HR 1.2, 95% CI 1.1-1.4, p = 0.006). No correlations were found between surgical complications and the H-index.
Conclusions. This study confirmed that the H-index is an independent prognostic factor for DFS in patients with HNSCC undergoing microvascular reconstructive surgery and should be used to better stratify the risk of mortality and recurrence, with the aim of improving patient management.

Preoperative vitamin D administration does not affect rates of post-thyroidectomy hypocalcaemia

Eyal Yosefof — 2025-09-23

Objective. Hypoparathyroidism is a common complication of total thyroidectomy, and the role of vitamin D deficiency in post-thyroidectomy hypocalcaemia is unclear. This study evaluates the role of preoperative vitamin D supplementation in reducing rates of postoperative hypocalcaemia.
Methods. This is a retrospective review of patients who underwent thyroidectomy before (n = 728) and after (n = 491) introduction of the routine preoperative active vitamin D in a tertiary medical centre. Patients were monitored for calcium support efficacy in managing hypocalcaemia.
Results. Demographics, preoperative calcium levels, pathologies, and surgeries were similar between groups. Postoperative calcium levels showed a smaller decrease in the study group (-0.5 mg/dL vs -0.62 mg/dL, p = 0.04). Short-term postoperative hypocalcaemia (< 8 mg/dL) occurred in 15.7% (patients treated between 1996-2009) and 14.5% (patients treated between 2010-2016) (p = 0.54). Symptomatic and long-term hypocalcaemia rates were also comparable (p = 0.88, p = 0.6). Central neck dissection and goiter/thyrotoxicosis were significantly associated with hypocalcaemia.
Conclusions. Pre-thyroidectomy vitamin D treatment does not prevent postoperative hypocalcemia. These findings suggest individualised calcium support strategies based on patient-specific factors post-thyroidectomy.

Should computed tomography be used in the evaluation of biologic therapies for severe chronic rhinosinusitis with nasal polyps?

Melania Bertolini — 2025-09-23

Socio-economic impact of cochlear implantation in adults: an Italian study

Annalisa Gatto — 2025-09-23

Objective. To analyse the cost-effectiveness of unilateral cochlear implant (CI) surgery in Italian adults with post-lingual deafness, focusing on direct costs, Health Utilities Index (HUI), QualityAdjusted Life Years (QALY), and Incremental Cost-Effectiveness Ratio (ICER).
Methods. The analysis, from the Italian healthcare system perspective, included preoperative, surgical, hospitalisation, and postoperative costs. QALYs were estimated using the Italian Nijmegen Cochlear Implant Questionnaire (I-NCIQ) and Ontario Health Utilities Index Mark 3 (HUI-3). HUI-3 score changes were analysed with regression models in Stat View (v5.0.1, SAS Institute Inc). ICER was calculated as the incremental cost per QALY (in Euros/QALY) over the average patient’s lifetime.
Results. CI significantly improved I-NCIQ (p < 0.001) and HUI-3 scores (p < 0.0001). Average life expectancy at surgery was 21.2 years; the degrade factor was 0.97, yielding a lifetime gain of 2.717 QALYs. Direct costs amount to €19,467.65. Cost-utility analysis showed €7,165.13 per QALY, below the €30,000/QALY ICER threshold.
Conclusions. CI surgery is cost-effective based on QALY analysis. Although cost-effectiveness decreases with age, quality of life and health benefits are comparable to younger patients.

Preliminary evaluation and reliability of the Italian adaptation of the dichotic digit test in adults and children

Federica Di Berardino — 2025-09-23

Background. Dichotic listening tests, such as the Dichotic Digit Test (DDT) developed by F. Musiek, are vital for assessing auditory processing disorders. There is a lack of validated auditory tests in Italian, necessitating the adaptation of existing tools.
Objective. This study aims to provide a preliminary assessment of the reliability and normative data for the newly adapted Italian version of the DDT. It hypothesises that the Italian DDT will show comparable reliability and normative data to the original English version, with a similar Right-Ear Advantage (REA).
Methods. The adaptation process involved a pilot study with 20 normal hearing adults, comparing the English and Italian versions of the DDT. Subsequently, the study included 138 children aged 6-10 years, using the Italian version to assess test-retest reliability and gather normative data.
Results. The findings revealed a consistent REA across participants that was more pronounced in younger children. The Italian version of DDT demonstrated adequate reliability across age groups and gender, with test-retest stability observed in both adults and children.
Conclusions. This preliminary study provides essential data on the reliability and normative scores of the Italian DDT. The findings support its use in clinical and research settings, although further studies are required for comprehensive validation.

Standardisation of an AI-based vocal fold assessment tool on a recurrent respiratory papillomatosis model

Mikolaj Buchwald — 2025-09-23

Objective. The assessment of extension of papilloma growth in recurrent respiratory papillomatosis (RRP) on vocal folds can be performed quantitatively utilising artificial intelligence (AI).
Methods. This study evaluated the efficacy of an AI-based annotation system, Glottis Coverage - Artificial Intelligence and Deep learning (GC-AID) in 4 patients to assess affected mucosa in white light (WL) and narrow band imaging modalities as a case-study for future applications.
Results. In healthy larynges, the mean difference between areas of the right and left vocal folds was minimal (2.6%). For patient # 4, following treatment, RRP coverage in WL decreased from 69.5% to 42.6%. A similar improvement was observed for patient # 1, while no significant benefits were noted for patients # 2 and # 3.
Conclusions. The extent of RRP was precisely measured with GC-AID before and after treatment.
Obtaining objective, quantitative results was possible with frame extraction and annotation using the system described herein.

The vascular anatomy of the internal auditory canal. A reappraisal for function preservation surgery

Antonio Mazzoni — 2025-09-23

Objectives. Partial or complete loss of function of the 7th and 8th nerves is a common occurrence in surgery of the cerebello-pontine angle, with the causal mechanism being considered the mechanical insult on nerves and the critical loss of blood supply to nerves and labyrinth. Preventing a vascular loss requires both soft surgery and knowledge of hitherto disregarded details of vascular anatomy. The goal of this paper is to provide the missing picture of descriptive and surgical anatomy.
Methods. Data of vascular anatomy were obtained from: (i) a group of 100 injected temporal bones submitted to microdissection; (ii) a group of 30 sectioned temporal bones; (iii) a group of 30 cases who underwent surgery for small vestibular schwannoma.
Results. A detailed picture was obtained concerning position and course of the anterior inferior cerebellar artery, origin and course of internal auditory artery (IAA) and its branches. Handling and cleavage of IAA from nerves was also explored.
Conclusions. The role of blood supply in function preservation of 7th-8th nerves comes from preclinical studies on animals as well as anatomical studies and clinical-surgical observations in humans. Updated knowledge of vascular anatomy is expected to provide surgeons with hitherto disregarded details and contribute to function preservation.

Impact of haemodialysis on vestibular function in adult patients with chronic kidney disease

Pasquale Viola — 2025-09-23

Objective. Chronic kidney disease (CKD) is a global health problem with a significant impact on patients’ quality of life. Haemodialysis, a common treatment for advanced CKD, can profoundly affect vestibular function, which plays a critical role in maintaining balance and spatial orientation.
Methods. This prospective study was conducted over a 6-month period at the Magna Graecia University and included 18 adult patients with CKD stage 5, undergoing haemodialysis. Vestibular function was assessed using the Visual Analogue Scale (VAS) for the symptom of unsteadiness and the video Head Impulse Test (vHIT) for the vestibulo-ocular reflex (VOR) gain.
Results. Our results showed a statistically significant decrease in VOR gain from 0.99 at T0 to 0.92 at T1 (T-test p = 0.034 and Welch Test p = 0.037), accompanied by an increase in VAS instability scores, after the dialysis session. These results suggest a worsening of vestibular function as a result of haemodialysis.
Conclusions. These results highlight the need for early diagnosis and timely intervention, such as vestibular rehabilitation, to reduce the risk of falls and improve the quality of life in CKD patients undergoing haemodialysis. Future research should investigate the long-term effects of haemodialysis on vestibular function.