ACTA Otorhinolaryngologica Italica

The Collegium Oto-Rhino-Laryngologicum Amicitiae Sacrum (CORLAS): what, when, now and future!

Alfio Ferlito — 2025-05-12

Clinicopathological and microbiological study of fungal rhinosinusitis treated with endoscopic surgery

Vladan Milutinović — 2025-01-15

Objective. The objective of this study was to analyse the aetiology, clinical presentations, histopathology and microbiological aspects of fungal rhinosinusitis (FRS) in patients undergoing endoscopic surgery.
Methods. The descriptive study was carried out over a 4-year period in two Serbian ENT Clinics and included patients with sinonasal pathology who underwent endoscopic surgery.
Results. The study included 26 patients. The most common forms of FRS treated by endoscopic sinus surgery was allergic FRS (AFRS). The fungus identification rate varied between entities, and was 72.2% in AFRS and 33.3% in fungal ball specimens. The common species seen in AFRS isolates were Cladosporium spp. (38.5% of isolated) and dematiaceous molds in the same percentage, while the remainder of the cultures were hyaline moulds. CT scan can be very helpful in diagnosing FRS and sometimes even in differentiating between different entities. Treatment of FRS should be tailored for each entity. Postoperative medical treatment in AFRS should consider potential advancements described in the literature.
Conclusions. This study emphasises the need to combine all types of clinical, radiology, pathohistological and microbiological methods to obtain the best diagnostic and treatment strategies and should be the basis for further research.

Adenoidectomy as day surgery: feasibility and outcomes

Giuseppe Musella — 2025-05-12

Objectives. Adenoidectomy performed as day surgery is a safe and cost-effective procedure, but patients may be occasionally admitted overnight due to the need for extended care. This study investigates the unplanned admission rate following day surgery adenoidectomy in children.
Methods. Data from 3,396 children who underwent adenoidectomy from 2010 to 2023 were retrospectively collected in a tertiary centre. Inclusion criteria were age > 2 years and ASA score I-II. The study focused on evaluating factors such as age, gender, duration of surgery, surgeon’s experience, adverse events and multiple surgeries. Univariate and multivariate analysis were performed, and ROC curves were built for continuous variables.
Results. The unplanned admission rate was 2.3%, with postoperative nausea/vomiting being the most common complication. Respiratory complications were notably low. Factors associated with unplanned admission at multivariate analysis included the end time of surgery (p < 0.001), surgical duration (p = 0.001) and surgeon’s experience (p < 0.001).
Conclusions. This study confirms the safety and feasibility of adenoidectomy as day surgery in a tertiary centre, with a low unplanned admission rate and infrequent serious complications. Further studies are needed to generalise these findings to different settings and populations.

The impact of the bitter taste receptor on the predisposition to chronic rhinosinusitis

Karolina Dżaman — 2025-05-12

Objectives. Genetic polymorphisms in bitter taste receptor 2 member 38 (TAS2R38), expressed in the cilia of sinonasal epithelial cells, have been proposed to be contributors to chronic rhinosinusitis (CRS).
Methods. We assessed the impact of the genetically determined TAS2R38 structure on predisposition to CRS and correlated the expression of the TAS2R38 with haplotypes. 86 patients (60 CRS patients, 26 controls) undergoing nasal surgery were enrolled. PCR to identify single nucleotide polymorphisms in genes encoding TAS2R38 were performed. TAS2R38 expression in sinus mucosa tissues was assessed by immunohistochemistry.
Results. Among CRS patients, the protective genotype PAV/PAV of the TAS2R38 was observed with the lowest frequency. Immunohistochemistry displayed significant overexpression of TAS2R38 in patients with CRS and in those with a non-functional AVI/AVI genotype. Under inflammatory conditions, TAS2R38 was found to translocate from the cell membrane.
Conclusions. Genetically determined TAS2R38 polymorphisms may influence susceptibility to CRS. The AVI haplotype seems to be an independent risk factor for CRS. Additionally, TAS2Rs and related signalling pathways might create a unique group of therapeutic targets in CRS.

In memory of Carlo Marchiori

Paolo Boscolo-Rizzo — 2025-05-12

Prof. Carlo Marchiori has left us, but his example and his scientific and human legacy will forever remain in the hearts of those who had the privilege of knowing him and working with him. Born in Venice on January 31, 1938, he pursued his academic career in Padua, where he trained under the prestigious otorhinolaryngology school of Prof. Michele Arslan. He was Full Professor and, for many years, Director of the Residency Program in Otorhinolaryngology at the University of Padua. His career developed through roles of primary importance, culminating in the direction of the University ENT Clinics of Padua and Treviso, where he left an indelible mark.

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https://www.actaitalica.it/article/view/1309/693

Cochlear Implant (CI) procedure. Italian Clinical Practice Guidelines of the Italian Society of Otorhinolaryngology (SIOeChCF) and Italian Society of Audiology and Phoniatrics (SIAF). Part 2: cochlear implants in children

Domenico Cuda — 2025-05-12

Objective. Cochlear implant (CI) is a well-established treatment for children with sensorineural hearing loss without benefit from hearing aids. The Italian guidelines date back 15 years; given the expansion of indications for CI (including single side deafness and asymmetrical hearing loss) it became necessary to establish updated guidelines.
Methods. Thirteen experts and 2 patient representatives selected the key questions and drew up recommendations. The document was developed following the GRADE methodology. The methodological team of the Mario Negri Pharmacological Research Institute performed systematic reviews for each question and supported the overall process.
Results. Four key questions were identified and recommendation formulated, with subgroups and implementation considerations.
Conclusions. Though the systematic research of scientific literature found a scarcity of randomised trials and an overall poor conduct and reporting quality of primary studies and systematic reviews, conditional recommendations in favour of CI have been formulated for different subgroups of children. Further studies should enrol a larger number of participants and use consistent instruments to evaluate hearing outcomes, in order to increase comparability of results and data pooling through meta-analysis.

The impact of immunonutrition in head and neck cancer surgery: a systematic review with meta-analysis

Claudia Lodovica Modesti — 2025-05-12

Objective. Malnutrition is common among patients undergoing surgery for head and neck cancer (HNC), leading to higher postoperative complications and mortality rates. Immunonutritional intervention has potential in reducing these risks by enhancing immune function and aiding wound healing.
Methods. A systematic review and meta-analysis were conducted according to PRISMA guidelines. Nineteen randomised controlled trials involving 1,196 participants undergoing surgery for HNC were included. Studies comparing immunonutrition with standard care were analysed for outcomes including fistula formation, wound infections, other infections, and length of hospital stay.
Results. Immunonutrition significantly reduced postoperative fistulas and shortened hospital stays compared to standard care. The impact on wound and systemic infections was inconclusive. Immunonutrition was generally well-tolerated, with no significant increase in adverse events.
Conclusions. These findings highlight the potential benefits of immunonutrition in improving postoperative outcomes for patients with HNC. However, the variability in study outcomes and limitations in quality call for further research to clarify the specific efficacy, long-term effects, and cost-effectiveness of immunonutrition in this context.

Identification of IGF2BP2 and long non-coding RNA TUG1 for the prognosis and tumour microenvironment in head and neck squamous cell carcinoma

Wenhui Yuan — 2025-01-15

Objective. This study aimed to investigate the role of m6A-related long non-coding RNAs (lncRNAs) in the prognosis and tumour microenvironment of head and neck squamous cell carcinoma (HNSCC).
Methods. 497 samples from The Cancer Genome Atlas were analysed to identify m6A-related lncRNAs via correlation models. Tripartite regression models, Kaplan-Meier analysis and nomograms were then utilised to assess the prognostic significance of these lncRNAs. Tumour mutation burden and immune cell infiltration analyses were also performed. Moreover, m6A-related lncRNAs expression and relation with IGF2BP2 were confirmed by RT-qPCR.
Results. The risk model revealed that high-risk scores predicted poorer survival outcomes. The area under ROC curves for predicting 1-, 3-, 5-year survival in the training set were 0.70, 0.68, and 0.64, respectively. Seven key m6A-related lncRNAs showed associations with immune checkpoint molecules, especially CTLA4 and PD-1. Finally, we found that knockdown of TUG1 repressed the expression of IGF2BP2.
Conclusions. Our results suggest that the m6A-related lncRNA risk model has potential clinical utility in predicting prognosis and immunotherapeutic responses in patients with HNSCC. Identification of candidate compounds for immunotherapy further emphasises the model’s relevance in guiding treatment decisions for HNSCC.

Utility of MRI quantitative analysis in assessment of audio-vestibular impairment

Rosalinda Calandrelli — 2025-05-12

Objectives. To quantify inner ear fluid changes in patients with audiovestibular deficits by measuring signal intensity values; to correlate the signal intensity values of inner ear structures and audio-vestibular impairment severity.
Methods. 26 patients with unilateral vestibulocochlear deficits underwent hearing and vestibular assessments and were categorised into severity classes using audiological and vestibular deficit scores. Normalised signal intensity values of inner ear structures were extracted from 3D-T2-WI-MRI scans (nT2mean, nT2Max, nT2min) and signal intensity ratios were calculated using the unaffected ear as a reference.
Results. Asymmetry ratios of nT2Max and nT2mean volumetric intensity values from the cochlea and entire inner ear discriminated severe hearing impairment from lesser deficits and diagnostic performance of nT2mean values was excellent.
Conclusions. Quantitative MRI analysis may be a useful tool to assess the severity of auditory deficits. Asymmetry ratios of nT2mean and nT2Max signal intensity values derived from the cochlea and entire inner labyrinth are surrogate indicators of unilateral cochlear-vestibular deficits and may have potential prognostic value.

Validation of the Comparative pre/post-treatment Self-Assessment of Dysphonia (CSAD) questionnaire: preliminary results

Andrea Ricci-Maccarini — 2025-05-12

Objective. This study aims to show preliminary results of the validation the Comparative pre/post-treatment Self-Assessment of Dysphonia (CSAD) questionnaire in assessing vocal quality and phonatory fatigue following treatment for dysphonia.
Methods. A retrospective analysis was conducted on 51 patients who underwent phonosurgery for various vocal diseases. Patients completed the CSAD questionnaire post-treatment, alongside the Voice Handicap Index (VHI-10) administered before and after treatment. Correlation analyses were performed between CSAD scores and differences in pre- and post-treatment VHI-10 scores.
Results. The CSAD demonstrated simplicity and ease of interpretation, requiring no pre-treatment administration. Despite its streamlined nature, it exhibited a satisfactory level of correlation with post-treatment VHI-10 scores, indicating its effectiveness in evaluating treatment outcomes for dysphonia.
Conclusions. The CSAD emerges as a simple yet effective tool for self-assessing vocal quality and phonatory fatigue after treatment in patients with dysphonia. Its straightforwardness and post-treatment administration make it a manageable and valuable addition to clinical practice, streamlining assessment processes without compromising accuracy.