Upper aerodigestive tract foreign body injury prevention: an ENT evidence-based perspective.
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Adolescent↗
Biomedical subjects
D Passàli
Publications and source records attributed to D Passàli.
Airbags and permanent auditory deficits. A real correlation?
OBJECTIVES: To evaluate the relationship between airbag-induced noise and individual metabolic risk factors in determining persistent hypoacusia in drivers after road accidents. METHODOLOGY: We selected 22 patients previously involved in a car accident with deployment of airbags. Patients underwent general and audiological clinical history, tonal audiometric examination, vocal audiometric examination, impedance meter examination and blood tests. RESULTS: We divided patients, according to audiometric data, into 2 groups: group A with no residual otological disturbances (6 subjects) and group B with persistent hypoacusia (16 subjects). Blood parameters were into physiological levels in all group A patients; on the contrary 12 (subgroup B1) out of 16 group B patients had altered blood levels of glucose, urea and cholesterol, with mean values of 155.8 +/- 38.6 mg/dl, 48.2 +/- 8.3 mg/dl and 250.8 +/- 28.1 mg/dl, respectively, revealing statistically significant differences in these parameters when compared with the other 4 hypoacusic cases (Sub-group B2) and with the normal subjects (Group A) (p < 0.01 for glucose, p < 0.05 for urea and p < 0.001 for cholesterol). CONCLUSIONS: Our findings confirm the transitory otological damage due to airbag deployment: the intensity of the acoustic wave hitting the ear after airbag deployment is responsible for a temporary rise in the acoustic threshold but the persistence of an auditory deficit can be due to co-factors able to interfere with the acute acoustic trauma recovery processes through a metabolic, angiopathic, neuropathic or unknown mechanism. Moreover, also the age of the patients could affect in a significant way the recovery from the acoustic trauma.
Accidents, Traffic↗
[Inflammation in otorhinolaryngology].
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Humans↗
Effects of dietary yoghurt on immunological and clinical parameters of rhinopathic patients.
OBJECTIVES: To examine the immunological and clinical influence of 4 months' feeding with either yoghurt or partially skimmed milk or nothing, on 20 volunteers. SUBJECTS: Thirteen subjects had a demonstrated allergic rhinopathy and seven were healthy subjects and participated as controls. RESEARCH DESIGN: Either a group of seven or a group of six rhinopathic patients were fed either 450 g yoghurt or 450 g partially skimmed milk, respectively, for 4 months between March and October 1999. All subjects maintained their usual diet throughout the study. Peripheral blood mononuclear cells (PBMC) were isolated before and after the experimental period and cultured for periods of 40 and 64 h. Proliferation index assay and release of IFNgamma and IL-4 without and with PHA stimulation were assessed. Allergic rhinopathy was evaluated before and after the 4 months period by performing the nasal functionality tests (Active Anterior Rhinomanometry, Acoustic Rhinometry), the prick test, the nasal specific provocation test (NPT), the dosage of specific IgE blood levels, the evaluation of the symptomatological score and the nasal mucociliary transport test. RESULTS: No significant change of the proliferation index was noted among the three groups. Cultured PBMC of the group fed with yoghurt released more IFNgamma and less IL-4. Cytokine plasma levels were at and remained at basal levels. Prick test, specific serum IgEs and NPT remained immodified. Muco-ciliary transport time (MCTt) and symptomatological score showed a definitive improvement after yoghurt feeding. CONCLUSION: Yoghurt feeding appears to improve or prevent allergic recurrences in rhinopatic patients.
Adult↗
Simplified local nasal immunotherapy in mite dust allergic rhinitis.
The present work aimed at evaluating the efficacy and tolerance of an alternative schedule of local nasal immunotherapy for the treatment of mite dust allergic rhinitis. The authors suggest the nasal administration of the maximum tolerated dosage chosen on the basis of nasal provocation test threshold, comparing allergen extracts in micronized powder and watery solution. Forty-five patients (25 men and 20 women), aged 18 to 66 years, affected by allergic rhinitis to Dermatophagoides (Dpt) were selected and treated either by local immunotherapy in watery solution (15) or in powder form (15) or by parenteral specific hyposensitizing treatment (15). Before and one year after the beginning of the study, the clinical diaries and the total and specific IgE variation were evaluated. The monthly symptoms and drugs use are comparable among the three treatment groups. No significant difference was found, with the exception of local symptomatology, which improved more in patients undergoing local immunotherapy (p > 0.05); and oral antihistamines use, which was lower in patients treated with the watery solution (p < 0.05). Thus, local simplified hyposensitizing treatment is able to combine the absence of symptomatological worsening with the decrease of both local and systemic drugs use. The advantages of the LNIT protocol proposed herein are as follows: simplified schedule for self-administration; improved patient compliance; reduction of local side effects; clinical efficacy comparable with subcutaneous specific immunotherapy.
Administration, Intranasal↗
Efficacy and safety of ketoprofen lysine salt mouthwash versus benzydamine hydrochloride mouthwash in acute pharyngeal inflammation: a randomized, single-blind study.
BACKGROUND: Pharyngodynia, or sore throat, is one of the symptoms most frequently reported by patients to primary care physicians. OBJECTIVE: The purpose of this study was to compare the efficacy and tolerability of mouthwash formulations of ketoprofen lysine salt (KLS), an anti-inflammatory agent, and benzydamine hydrochloride (BH), a local anesthetic, in patients with acute inflammation of the pharyngeal cavity. METHODS: In this randomized, multicenter, parallel-group, single-blind study, patients (who were blinded) were assigned to receive undiluted BH 15 mL (22.5 mg) or KLS 10 mL (160 mg) diluted in 100 mL of water. Both agents were gargled twice daily until pain remission or up to 7 days. A physical examination of the oropharyngeal cavity was performed, and severity of edema and hyperemia was assessed after 3 days of treatment and, if symptoms had not resolved, after pain remission. RESULTS: Of the 241 patients (120 KLS, 121 BH), 239 were included in the safety analysis and 232 were in the intent-to-treat population. The differences between groups in the duration of analgesic effect after the first dose of drug and the time course of pain were found to be statistically significant (P = 0.006 and P = 0.017, respectively), favoring KLS. Adverse drug-related effects reported included numbness of the tissues in the oral cavity, sensation of tingling in the tissues in the oral cavity, dry mouth, thirst, and nausea. A significantly greater proportion of BH-treated patients reported adverse events (P = 0.001 for all adverse events and drug-related adverse events). CONCLUSIONS: KLS mouthwash exerts a significantly longer first-application analgesic action with significantly greater local tolerability than BH in patients with pharyngeal pain of inflammatory and/or infectious origin.
Adolescent↗
[Idiopathic sudden hearing loss: role of the posterior communicating cerebral arteries of the Willis' circle].
Sudden hearing loss (SHL) is a neurosensorial hearing loss of variable entity with an onset of less than three days. In most cases (85-90%) it is of unknown etiology (idiopathic sudden hearing loss--ISHL). The most accredited hypotheses for origin are: viral, immunitary and vascular. ISHL accounts for approximately 1% of all neurosensorial hearing loss; onset is most frequent in winter, i.e. January and February, and it most frequently affects women, particularly at 15 and between 40-50 years of age. In order to evaluate the role of vascular condition on the onset of ISHL, we focused our attention on the circle of Willis. The results confirm that, in the absence of cerebro-vascular pathology, posterior communicating arteries (PCAs) that cannot be activated--evaluated by transcranial Doppler (TCD)--are associated with ISHL. Moreover, hemodynamic alterations detected in the basilar artery in ISHL patients are correlated with the final prognosis for hearing. These observations highlight the importance of TCD in testing subjects at risk for idiopathic SHL and show that PCAs are essential in maintaining normal cochlear function.
Adult↗
Amoxicillin/clavulanate in chronic rhinosinusitis: tissue and serum distribution.
UNLABELLED: Amoxicillin/clavulanate in chronic rhinosinusitis: tissue and serum distribution. OBJECTIVE: The aim of the present study is to determine the concentrations of coamoxiclav in the sinusal mucosa of patients undergoing surgery for chronic sinusitis in comparison to serum levels after single oral administration. METHODOLOGY: 24 patients affected by chronic sinusitis, undergoing sinus surgery, were divided into three groups receiving an oral dose of 1 g of coamoxiclav (875 mg amoxicillin, 125 g of clavulanic acid, 7:1 ratio) at 2 h (first group), 4 h (second group) and 6 h (third group) before surgery. The mean concentration of amoxicillin and clavulanic acid were determined biologically in serum and in tissues. RESULTS: The highest concentrations of coamoxiclav both in serum and tissues were observed in the group which received the antibiotic 2 hours before surgery. However the tissue levels of both amoxicillin and clavulanic acid in the time period within 2-6 h after administration were higher than the Minimum Inhibitory Concentration (MIC) for the most frequent causative pathogens of sinus bacterial infections. CONCLUSIONS: Since penicillins need to maintain concentrations above the MIC for at least 40 to 60% of the interval time between administrations to be potentially effective, the Authors concluded that since both amoxicillin and clavulanic acid spread well in the ENT tissues, 1 g twice a day of the combination seems to be clinically effective even in patients suffering from acute episodes of chronic rhinosinusitis.
Adolescent↗
Non-functioning posterior communicating arteries of circle of Willis in idiopathic sudden hearing loss.
Most cases of sudden hearing loss have no identifiable cause. A link between compensatory blood flow through the circle of Willis and recovery from sudden hearing loss has, however, been suggested. We assessed 22 patients with sudden hearing loss who had no cerebrovascular disease, and 41 controls matched for age and sex. We took ultrasonographic doppler flow measurements of the extracranial carotid and vertebrobasilar systems and independent audiological measurements. 12 patients with sudden hearing loss, compared with four controls had bilateral non-functioning posterior communicating arteries (p=0.00019). Our findings suggest a strong association between a non-functioning posterior communicating artery of the circle of Willis and sudden hearing loss.
Adult↗
A new method for endoscopic evaluation in rhinology: videocapture.
The aim of the study is to analyze a new method for the elaboration of endoscopic images of the nasal cavity called "videocapture" and to compare the data from this technique with the ones obtained with anterior active rhinomanometry. Videocapture is based on a software program able to process endoscopic images, to file them and to measure perimeter and area of the structures inside the images recorded. We enrolled 27 patients with inferior turbinate hypertrophy and we performed, before and after nasal decongestion test, anterior active rhinomanometry, acoustic rhinometry, videocapture to compare the results obtained with these different techniques. The results we got confirm in a statistically significant way, the reliability of videocapture and its easy way of application.
Adult↗
The role of rhinomanometry, acoustic rhinometry, and mucociliary transport time in the assessment of nasal patency.
We conducted a study of 60 patients with different nasal pathologies who complained of nasal obstruction. Our goal was to evaluate the reliability of rhinomanometry, acoustic rhinometry, and the measurement of mucociliary transport time in helping make the diagnosis of nasal pathologies. We also sought to discover whether there is a correlation between the findings of these objective tests and the results of patients' own subjective assessments of nasal obstruction. We found that acoustic rhinometry was more specific and more sensitive than rhinomanometry in diagnosing rhinopathies in patients with structural anomalies. Symptom scores as rated by patients on the visual analog scale frequently did not correlate with objective measures, as patients often overestimated the severity of their obstruction. However, for a few patients, there was a correlation between symptom scores and mucociliary transport times.
Acoustics↗
Alterations of nasal mucociliary transport in patients with hypertrophy of the inferior turbinates, deviations of the nasal septum and chronic sinusitis.
Mucociliary transport (MCT) represents the first barrier of the nasal fossae and paranasal sinuses against various biological and physical insults. We studied the nasal MCT time using a mixture of vegetable charcoal powder and 3% saccharin in three groups of patients suffering from hypertrophy of the inferior turbinates, deviations of the nasal septum or chronic sinusitis. The mean values of the nasal MCT in the first two groups were practically identical to the normal ones. In contrast, significantly delayed times were found in patients with chronic sinusitis (P < 0.01). Findings indicate that this delay is determined by an increase in viscoelasticity of the mucus following the acute release of mediators of inflammation, together with a reduction in the periciliary stratum, which slows down the metachronous wave of the MCT.
Adolescent↗
ABR evaluation of ototoxicity in cancer patients receiving cisplatin or carboplatin.
The development of ototoxicity was evaluated using auditory brainstem response (ABR) in cancer patients randomized to receive a cisplatin-based chemotherapy (cisplatin dose: 70 mg/m2) or a carboplatin-based chemotherapy (carboplatin dose: 250 mg/m2). The ABR measurements were performed in a sound-treated room using 2000 clicks of alternating polarity at an intensity of 100 dB PESPL presented to the patients at a rate of 21 clicks per second. Of 59 patients, 21 (9 in the cisplatin group and 12 in the carboplatin group) met our pre-established criteria and were included in the ototoxicity study. Two patients of the cisplatin group developed evidence of clinically occult ototoxicity after two cycles of chemotherapy; the latency of wave V of the ABR increased significantly from 5.874 to 6.336 msec and from 5.826 to 6.458 msec in both patients; these patients had a hearing loss detected by conventional audiometry (125 to 8,000 Hz) after five and six cycles of chemotherapy, respectively. None of the 12 examined carboplatin patients developed ABR-measured ototoxicity or abnormal audiograms during treatment. Our results suggest that ABR might prove to be useful in detecting early hearing deterioration from cisplatin.
Aged↗
Treatment of hypertrophy of the inferior turbinate: long-term results in 382 patients randomly assigned to therapy.
A number of surgical techniques are commonly performed to control the symptoms of inferior turbinate hypertrophy unresponsive to medical treatment. We report long-term results in 382 patients randomly assigned to receive electrocautery (62), cryotherapy (58), laser cautery (54), submucosal resection without lateral displacement (69), submucosal resection with lateral displacement (94), and turbinectomy (45). Outcomes of objective test results from rhinomanometry, acoustic rhinometry, mucociliary transport time, and secretory immunoglobulin A levels were compared to the symptom scores before and yearly after surgical treatment. These data indicate that submucosal resection with lateral displacement of the inferior turbinate results in the greatest increases in airflow and nasal respiratory function with the lowest risk of long-term complications.
Adolescent↗
[Endonasal dacryocystorhinostomy: a personal experience].
Stenosis of the naso-lachrymal duct as a consequence of acute or chronic inflammation, trauma or congenital malformation is a relatively frequent lachrymal duct pathology. The symptoms include epiphora and intermittent tumefaction of the medial ocular canthus, indicative of a deficiency in lachrymal drainage. If such conditions do not respond to medical treatment, lavage and transcanicular probe, surgery proves necessary. Modern techniques for endonasal surgery place the otologist in the forefront in the surgical treatment of this disorder. Endonasal dacryocystorhinostomy (DCR) is indeed a valid alternative to traditional extra-nasal surgery; once exclusively the domain of the ophthalmologist. However, it does require a certain expertise in micro-endoscopic surgery. In most cases sophisticated equipment is not required and the procedure can be performed with just a few instruments: electric knives, scalpel and Citelli forceps. Endonasal DCR makes skin incisions unnecessary and makes it possible to reveal, and possibly, correct, any sequela subsequent to traditional DCR such as ethmoidal rhino-sinusitis or the presence of adhesions. In the present work 67 patients--24 with recurrence after traditional surgery--underwent endonasal DCR within the last 22 months and with an average follow-up of one year. Surgery was successful in 90% of the cases.
Adult↗
[Iatrogenic and non-iatrogenic factors as causes of progressive sensorineural hearing loss].
The aim of our study was to analyze factors such as noise, chemical drugs, industrial solvents and radiotherapy, which can cause cochlear lesions with progressive sensorineural hearing loss. Although an acute overstimulation by acoustic energy may induce an irreversible hearing loss, in most cases the noise-induced deafness is related to the duration of the exposure and to the level of the acoustic stimulation. A permanent hearing deficit occurs when the acoustic level exceeds 85 dBs. Also several classes of drugs are described as having ototoxic potential: aminoglycoside antibiotics, loop diuretics, antimalarial drugs such as quinine, salicylates, some chemotherapeutic antineoplastic agents. Their potential ototoxic effect seems to be related not only to the molecule, but also to individual predisposition, dose and route of administration. Regarding the benzene derivatives, there is a relationship between their ototoxicity and factors such as duration of exposure and concentration in the local environment. Finally, radiotherapy to areas near the temporal bone may produce a degenerative insult to the vascular stria and the hair cell causing a progressive sensorineural hearing loss.
Disease Progression↗
[Comparative study of the effect of vasoconstrictive and balsamic agents in the decongestant nasal test].
The authors report a study of 60 subjects with mono or bilateral nasal obstruction of different etiologies (30 vasomotor rhinopathy, 30 septum deviations) evaluating the decongestion action of a vasoconstrictor. This substance for topic use was administered in pill form both in association with and without different balsamic substances. The patients underwent subjective evaluation using a visual analogy scale (VAS) and an objective test such as active anterior rhinomanometry (AAR) and acustic rhinometry (AR). All evaluations were performed under basal conditions and after the nasal decongestion test (NDT). The results were processed in order to evaluate: a) relationships between the subjective results (VAS) and the objective instrumental tests (AAR and AR); b) the mechanism by which the balsamic substances affect the symptoms. The purpose was to evaluate exactly how important balsamic substances are in topic vasoconstrictor preparations. Finally, an attempt was made to confirm the importance of the nasal decongestion test to provide a concise diagnostic picture and a suitable medical or surgical approach to "nasal obstruction" symptoms. Among other things, the results underline the importance of objective methods; thanks to their reliability they now provide an essential support in the surgical indications and in following-up every nasal obstruction treatment, even as regards forensic medicine. From a strictly pharmacological point of view, whether associated with balsamic substances or not, vasoconstrictors give similar results with all evaluation methods. On the other hand, the balsamic action is limited to a subjective sensation of increased nasal air flow stemming from the stimulation of cutaneous thermoreceptors in the vestibule. Although this sensation does not correspond to an objective reduction in nasal resistance, it cannot be neglected in the treatment of obstructive symptoms where the psychological component can play an important role.
Acoustics↗
The historical background of allergic rhinopathy therapy.
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Anti-Allergic Agents↗