Publications by authors named "Francesco Bussu"

61 Publications

Submandibular gland degloving: A minimally invasive function-preserving surgical approach for benign diseases.

Head Neck 2021 May 4. Epub 2021 May 4.

Otolaryngology Division, Azienda Ospedaliero Universitaria, Sassari, Italy.

In the Video S1, a modified technique for submandibular gland resection in benign disease is shown. The main plane of dissection is below the fascia and immediately superficial to the fibrous capsule of the gland. The video shows the surgical steps and the structures that become evident along the procedure and illustrates some tips and tricks. Facial vessels are dissected, easily spared, and not ligated as it occurs in the classical technique. This technical variant is minimally invasive, respectful of anatomy, and through preservation of the fascial layer investing the gland aims at reducing the risk of injury to the marginalis mandibulae branch of the facial nerve, which lies within the fascia itself.
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http://dx.doi.org/10.1002/hed.26728DOI Listing
May 2021

Audiovestibular symptoms and sequelae in COVID-19 patients.

J Vestib Res 2021 Feb 10. Epub 2021 Feb 10.

Division of Otolaryngology, Department of Medical, Surgical and Experimental Science, University of Sassari, Italy.

Background: since the beginning of COVID-19 outbreak a growing number of symptoms and deficits associated with the new pathology have emerged, among them cochlear damage in otherwise asymptomatic COVID-19 patients has been described.

Objective: to investigate general and audiovestibular symptoms and sequelae in healed patients, and to seek for any sign of residual or permanent hearing or vestibular loss.

Methods: we reviewed the data coming from 48 Covid-19 patients whose nasopharyngeal swabs have turned negative, all employed at our facility, that opted in for a free screening of audiovestibular symptoms offered by our hospital after the aforementioned report was published. The screening included a tonal pure tone audiometry, a vHIT and SHIMP test, as well as a survey including known symptoms and audiovestibular symptoms.

Results: general symptoms as reported by our patients largely reflect what reported by others in the literature. 4 (8.3%) patients reported hearing loss, 2 (4.2%) tinnitus, 4 dizziness (8.3%), 1 spinning vertigo (2%), 1 dynamic imbalance (2%), 3 static imbalance (6.3%). Most audiovestibular symptoms have regressed. Thresholds at pure tone audiometry and vHIT gain were within normality range in all post-Covid-19 patients.

Conclusions: even if some patients suffer from audiovestibular symptoms, these are mostly transitory and there is no clear evidence of clinically relevant persistent cochlear or vestibular damage after recovery.
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http://dx.doi.org/10.3233/VES-201505DOI Listing
February 2021

Utility of ultrasound-guided fine needle aspiration cytology in assessing malignancy in head and neck pathology.

Cytopathology 2021 Jan 26. Epub 2021 Jan 26.

Otolaryngology Division, Azienda Ospedaliera Universitaria, Sassari, Italy.

Objective: Fine needle aspiration cytology (FNAC) is a well-established diagnostic procedure for head and neck masses not clearly originating from mucosal or cutaneous surfaces. We analysed head and neck masses evaluated over a 2-year period, to assess the reliability of FNAC for the evaluation of malignancy.

Methods: We enrolled all patients undergoing FNAC, from April 2013 to July 2015, in a single service of a large Italian university hospital. Relevant clinical data and ultrasonographic parameters of the lesions were recorded. We performed both conventional and thin-prep smears. Clinical presentation, ultrasonographic features and final cytology diagnoses were analysed and correlated with histology.

Results: The series included 301 lesions in 285 patients, with a single (94.4%) or two (5.6%) lesions. Only eight samples were considered non-diagnostic/inadequate (2.6%). Among the cases, 139 FNAC (46.1%) underwent surgery. Cytological-histological correspondence was found in 89% of the cases. Concerning malignancy, we documented less than 4% false positives and less than 2.5% false negatives, with 92.7% sensitivity and 94.6% specificity.

Conclusion: FNAC diagnosis can be highly specific. Most importantly, it is highly reliable in assessing malignancy, thus defining the priority and guiding the management procedures.
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http://dx.doi.org/10.1111/cyt.12955DOI Listing
January 2021

Periprosthetic Leakage in Tracheoesophageal Prosthesis: Proposal of a Standardized Therapeutic Algorithm.

Otolaryngol Head Neck Surg 2021 Jan 5:194599820983343. Epub 2021 Jan 5.

ENT Division, Ospedale Cardinale G. Panico, Tricase, Italia.

Objective: Periprosthetic leakage represents the most demanding long-term complication in the voice prosthesis rehabilitation. The aim of this article is to discuss the various causes of periprosthetic leakage and to propose a systematic management algorithm.

Study Design: Retrospective cohort study.

Setting: Otolaryngology clinic of the University Polyclinic A. Gemelli-IRCCS Foundation.

Methods: The study included 115 patients with voice prosthesis who were treated from December 2014 to December 2019. All patients who experienced periprosthetic leakage were treated with the same step-by-step therapeutic approach until it was successful. Incidence, management, and success rate of every attempt are analyzed and discussed.

Results: Periprosthetic leakage was reported 330 times by 82 patients in 1374 clinic accesses. Radiotherapy, timing of tracheoesophageal puncture, and type of total laryngectomy (primary or salvage) did not influence the incidence of periprosthetic leakage. Salvage total laryngectomy increases the risk of more clinically relevant leakages.

Conclusion: By using a systematic algorithm with a step-by-step standardized approach, periprosthetic leakage management could become a less treacherous issue.
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http://dx.doi.org/10.1177/0194599820983343DOI Listing
January 2021

A challenging complication following SARS-CoV-2 infection: a case of pulmonary mucormycosis.

Infection 2020 Dec 17. Epub 2020 Dec 17.

Intensive Care Unit, Emergency Department, AOU Sassari, Sassari, Italy.

Severe acute respiratory syndrome coronavirus 2 infection might induce a significant and sustained lymphopenia, increasing the risk of developing opportunistic infections. Mucormycosis is a rare but severe invasive fungal infection, mainly described in immunocompromised patients. The first case of a patient diagnosed with coronavirus disease (COVID-19) who developed a pulmonary mucormycosis with extensive cavitary lesions is here reported. This case highlights how this new coronavirus might impair the immune response, exposing patients to higher risk of developing opportunistic infections and leading to worse outcomes.
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http://dx.doi.org/10.1007/s15010-020-01561-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7745708PMC
December 2020

Interventional radiotherapy as exclusive treatment for primary nasal vestibule cancer: single-institution experience.

J Contemp Brachytherapy 2020 Oct 30;12(5):413-419. Epub 2020 Oct 30.

Divisione di Otorinolaringoiatria, Azienda Ospedaliero Universitaria, Sassari, Italy.

Purpose: The aim of this paper was to evaluate treatment outcomes following interventional radiotherapy (brachytherapy - BT) for nasal vestibule cancer.

Material And Methods: Considering histological diagnosis and staging, a multidisciplinary tumor board indicated an exclusive interventional radiotherapy for all patients. Plastic tubes were placed mainly with interstitial approach. The total dose was 44 Gy in 14 fractions, 3 Gy/fraction (except for the first and last fractions, 4 Gy), 2 fractions per day (b.i.d.), 5 days a week. Inclusion criteria for this analysis were: patients affected by squamous cell carcinoma with follow-up more than 6 months.

Results: 20 patients with primary nasal vestibule cancer were treated with IRT from May 2012 to June 2019. We excluded 4 patients due to follow-up less than 6 months and 2 patients affected by basal cell carcinoma. In total, 14 consecutive previously untreated patients were considered for definitive analysis, median age was 67.5 (range, 51-83) years, median follow-up was 53 (range, 6-84) months. All patients followed the protocol except one, who received a total dose of 42 Gy in 12 fractions, 3 Gy per 6 fractions, and 4 Gy per 6 fractions. Local control at 12, 24, and 36 months was 85.7%. Overall survival at 12 months was 92.3%, at 24 months was 76.9%, and at 36 months was 69.2%. Staging system proposed by Wang was statistically significant on local control (LC), disease-free survival (DFS), disease-specific survival (DSS), and overall survival (OS). Excellent cosmetic results were observed.

Conclusions: This study confirms that interventional radiotherapy could be considered as a definitive treatment in nasal vestibule cancer with excellent oncological and cosmetic outcomes.
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http://dx.doi.org/10.5114/jcb.2020.100373DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7701927PMC
October 2020

Relationship between calcium metabolism and benign paroxysmal positional vertigo in north Sardinia population.

J Vestib Res 2020 ;30(6):375-382

Azienda Ospedaliero Universitaria, Otolaryngology Division, Sassari, Italy.

Background: Benign paroxysmal positional vertigo (BPPV) has a reported recurrence ranging from 26.8 to 50%. Osteoporosis and Vitamin D deficiency seems to have an impact on recurrence of BPPV.

Objective: to evaluate the impact of osteoporosis and Vitamin D deficiency on recurrence of BPPV.

Methods: 73 consecutive patients were divided in two groups according to the presence (group 1) or absence (group 0) of a recurrent episode. BMD, femoral and lumbar T-scores and Vitamin D levels were recorded. Statistical analysis was performed to investigate correlations.

Results: patients in group 1 had statistically significant lower values of both femoral (-1,62±1,06 vs. -0,53±1,51; p = 0,001), lumbar T-score (-2,10±1,19 vs -0, 53±1.51, p = 0.001) and Vitamin D (19.53±15.33). The values of femoral T-score and Vitamin D could be combined in a model able to properly classify 65.8% of the cases (p = 0.002) as isolated or recurrent BPPV, with high accuracy (AUC 0.710 [0.590 -0.830]).

Conclusion: present data show a probable correlation between osteoporosis and Vitamin D with recurrent BPPV.
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http://dx.doi.org/10.3233/VES-200025DOI Listing
January 2020

Not only gustatory sweating and flushing: Signs and symptoms associated to the Frey syndrome and the role of botulinum toxin A therapy.

Head Neck 2021 Mar 28;43(3):949-955. Epub 2020 Nov 28.

Division of Otorhinolaryngology, Department of Aging, Neuroscience, Orthopedics and Head and Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

Background: The classic symptoms of Frey syndrome are gustatory sweating and flushing. Aims of the study were to describe prevalenceand severity of typical and atypical presentations of the disorder and to assess the effects of botulinum neurotoxin A (BoNT-A) therapy in patients with Frey syndrome after parotidectomy.

Methods: In this prospective, observational study on 18 patients, we assessed symptom severity before therapy, after 15 days, 1, 3 and 6 months' follow-up with the sweating-flushing-itch-paresthesia-pain (SFIPP) Frey scale specifically designed by the authors themselves for this study.

Results: Before BoNT-A injection, all patients (100%) complained gustatory sweating, 80% paresthesia, 77% gustatory flushing, 60% pain and 60% gustatory itch. The SFIPP-Frey overall score and the symptom-specific ones decreased significantly at each post-therapy control.

Conclusions: The prevalence of "unusual" manifestations is not negligible. BoNT-A improves symptoms severity. The SFIPP-Frey scale may be useful to assess symptoms and to monitor post-therapy outcomes.
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http://dx.doi.org/10.1002/hed.26561DOI Listing
March 2021

A one-year time frame for voice prosthesis management. What should the physician expect? Is it an overrated job?

Acta Otorhinolaryngol Ital 2020 Aug;40(4):270-276

Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Istituto di Otorinolaringoiatria, Rome, Italy.

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http://dx.doi.org/10.14639/0392-100X-N0587DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7586190PMC
August 2020

Functional results of exclusive interventional radiotherapy (brachytherapy) in the treatment of nasal vestibule carcinomas.

Brachytherapy 2021 Jan-Feb;20(1):178-184. Epub 2020 Oct 9.

UOC di Otorinolaringoiatria, Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della testa collo. Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Institute of Otolaryngology, Università Cattolica del Sacro Cuore, Policlinico Agostino Gemelli, Rome, Italy.

Purpose: Surgery, external beam radiotherapy (EBRT), and interventional radiotherapy (IRT, BrachyTherapy BT) are the current therapeutic options for nose vestibule (NV) squamous cell carcinoma (SCC). In this article, we evaluate the nose functional parameters of patients affected by SCCs of the NV, primarily treated by interstitial IRT comparing them with healthy controls and with patients treated with intensity-modulated EBRT.

Methods: Ten patients treated by using IRT (group 1), 10 healthy controls and eight patients treated by EBRT (group 2) on the region of the nose were submitted to clinical evaluation (with the NOSE scale score), rhinomanometry, olfactory testing, nasal citology, and evaluation of mucociliary clearance through saccharine test.

Results: No long-term skin or cartilaginous toxicity are recorded. The olfactometry threshold discrimination identification TDI is lower in EB group. The mean NOSE scale score was significantly higher in group 2 than in group 1 and healthy controls (p < 0.05). The distribution of cytologic patterns resulted significantly different as well. Patients treated by EB have a significantly impaired mucociliary clearance, with a mean time for the transport of the stained marker, which is more than double in the patients treated by EB than in those treated with IRT (p < 0.001).

Conclusions: Nasal function and cytological findings are significantly better, substantially preserved, in patients treated by IRT than in those treated by EBRT, bringing new relevant evidence for the establishment of interstitial IRT as the new standard for the treatment of the primary lesion in cT1 and cT2 -Wang staging NV SCCs.
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http://dx.doi.org/10.1016/j.brachy.2020.08.008DOI Listing
October 2020

Does the involvement of first-year residents have a negative impact on the performance of a newborn hearing screening program?

Int J Pediatr Otorhinolaryngol 2020 Nov 8;138:110270. Epub 2020 Aug 8.

IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Area Testa e Collo, UOC Otorinolaringoiatria, Rome, Italy.

Objectives: We aimed to evaluate the efficiency of our hearing screening program, prior to hospital discharge, together with the consistency of our teamwork including first year residents by assessing a learning curve for the operators involved.

Methods: We evaluated all the data collected during the first stage of the screening program of all non-NICU neonates from March 2009 to July 2013, analyzing by means of a linear regression model, the monthly referral rate for the whole period of activity of each group of residents.

Results: performances of each group of screeners were statistically different (chi square test p < 0.005). The nptrend test showed that group 2 (p = 0.01) and group 4 (p = 0.01) reached a statistical significance in higher and lower referral rates respectively. No statistical differences were found in other groups (Group 1 p = 0.161; Group 3 p = 0.853).

Conclusion: Despite a statistically significant difference in the performances between the groups of residents, the referral rates for each group (range 6.18%-9.29%) and the overall referral rate for the whole period (7.84%) agree with the values commonly reported for TEOAEs in the literature. It means that our screening program is reasonably effective despite a yearly turnover of operators.
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http://dx.doi.org/10.1016/j.ijporl.2020.110270DOI Listing
November 2020

Patients With Voice Prosthesis Rehabilitation During the COVID-19 Pandemic: Analyzing the Effectiveness of Remote Triage and Management.

Otolaryngol Head Neck Surg 2021 02 4;164(2):277-284. Epub 2020 Aug 4.

Unità Operativa Complessa di Otorinolaringoiatria, Area Testa-Collo, Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.

Objective: To describe a remote approach used with patients with voice prosthesis after laryngectomy during the COVID-19 pandemic and the resulting clinical outcomes in terms of voice prosthesis complications management, oncological monitoring, and psychophysical well-being.

Study Design: Prospective cohort study.

Setting: Otolaryngology Clinic of the University Polyclinic A. Gemelli, IRCCS Foundation.

Subjects And Methods: All patients with voice prosthesis who underwent laryngectomy followed by our institute were offered enrollment. Patients who agreed to participate were interviewed to inquire about the nature of the need and to plan a video call with the appropriate clinician. Before and 1 week after the clinician's call, patients were tested with the Hospital Anxiety and Depression Scale. Degrees of satisfaction were investigated with a visual analog scale. A comparison between those who accepted and refused telematic support was carried out to identify factors that influence patient interest in teleservice.

Results: Video call service allowed us to reach 37 (50.68%) of 73 patients. In 23 (62.16%) of 37 cases, the video call was sufficient to manage the problem. In the remaining 14 cases (37.83%), an outpatient visit was necessary. Participants who refused telematic support had a significantly shorter time interval from the last ear, nose, and throat visit than patients who accepted (57.95 vs 96.14 days, = .03). Video-called patients showed significantly decreased levels of anxiety and depression (mean Hospital Anxiety and Depression Scale total score pre- vs post-video call: 13.97 vs. 10.23, < .0001) and reported high levels of satisfaction about the service.

Conclusion: Remote approach may be a viable support in the management of patients with voice prosthesis rehabilitation.
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http://dx.doi.org/10.1177/0194599820948043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7404089PMC
February 2021

Medical-surgical management and clinical outcome in cervical abscesses.

J Infect Dev Ctries 2020 05 31;14(5):527-531. Epub 2020 May 31.

Otolaryngology Division, Department of Medical, Surgical and Experimental sciences, University of Sassari, Sassari, Italy.

Introduction: This study aims at defining through a retrospective evaluation, the clinical parameters affecting the clinical course and consequently the management of patients presenting with cervicofacial abscesses.

Methodology: A total of 394 patients diagnosed with abscess at the University of Sassari Otorhinolaryngology Division between 2009 and 2017 were included; among these, eleven patients were diagnosed with necrotizing fasciitis. Personal and clinical parameters including the LRINEC score and the medical and/or surgical treatment used were analyzed for each patient. The most frequently affected site was the peritonsillar space (76.9%), followed by the parapharyngeal space.

Results: Mean age was 41(±17) years, the male population was slightly overrepresented (68%). An average of 6 (±7) days of hospitalization duration was recorded. The mortality rate was confirmed to be relatively low (1/349 patients) and was reported only in one patient diagnosed with necrotizing fasciitis (1/11).

Conclusion: Diagnosis, correct clinical definition and early medical-surgical treatment of neck abscesses were crucial to reduce complications; LRNEC score, C-reactive protein, glycemia and creatininemia proved to be reliable prognostic indicators of difficult patient management and risk of complications.
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http://dx.doi.org/10.3855/jidc.12191DOI Listing
May 2020

Nasopharyngeal swab collection in the suspicion of Covid-19.

Am J Otolaryngol 2020 Sep - Oct;41(5):102551. Epub 2020 May 27.

Azienda Ospedaliero Universitaria, Otolaryngology Division, Sassari, Italy; Otolaryngology, Dipartimento delle Scienze Mediche, Chirurgiche e Sperimentali, Università di Sassari, Italy.

RT-PCR detection of SARS-CoV-2 mRNA on nasopharyngeal swab is the standard for diagnosing active Covid-19 disease in asymptomatic subjects and in symptomatic patients without the typical radiological findings. Nasopharyngeal swabbing appears a trivial procedure, still an inappropriate nasopharyngeal sampling, performed by untrained operators, can be a relevant cause of false negative findings with a clear negative impact on the effort to control the epidemic and, when PPE is not properly used, this can expose healthcare workers and patients to risks of contagion.
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http://dx.doi.org/10.1016/j.amjoto.2020.102551DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7255165PMC
September 2020

Inappropriate Nasopharyngeal Sampling for SARS-CoV-2 Detection Is a Relevant Cause of False-Negative Reports.

Otolaryngol Head Neck Surg 2020 09 26;163(3):459-461. Epub 2020 May 26.

Otolaryngology Division, Azienda Ospedaliero Universitaria di Sassari, Sassari, Italy.

Reverse transcriptase polymerase chain reaction (RT-PCR) detection of SARS-CoV-2 mRNA on nasopharyngeal swab is the standard for diagnosing active COVID-19 disease in asymptomatic cases and in symptomatic patients without the typical radiologic findings. For the present COVID-19 outbreak in Italy, we describe 4 symptomatic patients with negative RT-PCR results at the first nasopharyngeal swab, which became positive when collected a few hours later by an otolaryngologist. All the patients showed nasal obstruction. The present report suggests that inadequate nasopharyngeal sampling performed by untrained operators in the presence of nasal obstruction can be a relevant case of false-negative findings at RT-PCR, with a clear negative impact on the efforts to contain the current outbreak.
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http://dx.doi.org/10.1177/0194599820931793DOI Listing
September 2020

Olfactory and gustatory function impairment in COVID-19 patients: Italian objective multicenter-study.

Head Neck 2020 Jul 21;42(7):1560-1569. Epub 2020 May 21.

Maxillofacial Surgery Operative Unit, University Hospital of Sassari, Sassari, Italy.

Background: Objective data on chemosensitive disorders during COVID-19 are lacking in the Literature.

Methods: Multicenter cohort study that involved four Italian hospitals. Three hundred and forty-five COVID-19 patients underwent objective chemosensitive evaluation.

Results: Chemosensitive disorders self-reported by 256 patients (74.2%) but the 30.1% of the 89 patients who did not report dysfunctions proved objectively hyposmic. Twenty-five percentage of patients were seen serious long-lasting complaints. All asymptomatic patients had a slight lowering of the olfactory threshold. No significant correlations were found between the presence and severity of chemosensitive disorders and the severity of the clinical course. On the contrary, there is a significant correlation between the duration of the olfactory and gustatory symptoms and the development of severe COVID-19.

Conclusions: Patients under-report the frequency of chemosensitive disorders. Contrary to recent reports, such objective testing refutes the proposal that the presence of olfactory and gustatory dysfunction may predict a milder course, but instead suggests that those with more severe disease neglect such symptoms in the setting of severe respiratory disease.
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http://dx.doi.org/10.1002/hed.26269DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7280583PMC
July 2020

Objective evaluation of anosmia and ageusia in COVID-19 patients: Single-center experience on 72 cases.

Head Neck 2020 06 29;42(6):1252-1258. Epub 2020 Apr 29.

Maxillofacial Surgery Operative Unit, University Hospital of Sassari, Sassari, Italy.

Background: The first European case series are detecting a very high frequency of chemosensitive disorders in COVID-19 patients, ranging between 19.4% and 88%.

Methods: Olfactory and gustatory function was objectively tested in 72 COVID-19 patients treated at University Hospital of Sassari.

Results: Overall, 73.6% of the patients reported having or having had chemosensitive disorders. Olfactory assessment showed variable degree hyposmia in 60 cases and anosmia in two patients. Gustatory assessment revealed hypogeusia in 33 cases and complete ageusia in one patient. Statistically significant differences in chemosensitive recovery were detected based on age and distance from the onset of clinical manifestations.

Conclusion: Olfactory and gustatory dysfunctions represent common clinical findings in COVID-19 patients. Otolaryngologists and head-neck surgeons must by now keep this diagnostic option in mind when evaluating cases of ageusia and nonspecific anosmia that arose suddenly and are not associated with rhinitis symptoms.
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http://dx.doi.org/10.1002/hed.26204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7267244PMC
June 2020

Listening to music while running alters ground reaction forces: a study of acute exposure to varying speed and loudness levels in young women and men.

Eur J Appl Physiol 2020 Jun 10;120(6):1391-1401. Epub 2020 Apr 10.

Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/b, 07100, Sassari, Italy.

Purpose: Music listening while running enhances physiological and psychological features, resulting in a more enjoyable experience. The possible influence of music on ground reaction forces (GRF) during running, however, is unknown. Considering the 'distracting' role of music on runner's attention, we hypothesized that music would cover foot impacts against the ground. This study verified such hypothesis by testing the effects of different music volumes while running at different velocities.

Methods: Fifty fit volunteers (F:M = 22:8; 23 ± 2 years) performed 2-min running stints over 3 random conditions (80-dB, 85-dB music; 'no music'), at 3 velocities (8, 10, 12 km/h). Participants ran on a sensorized treadmill that recorded GRF during all experiments.

Results: Listening to 85-dB music resulted in greater GRF at 8 (p = 0.0005) and 10 km/h (p = 0.04) but not 12 km/h (p = 0.35) and not with 80-dB volume. Gender-based analyses revealed significant Condition × gender interactions only for 85-dB music vs. 'no music'. Bonferroni-adjusted comparisons revealed significant music-induced increases in GRF only in men at 8 km/h (+ 4.1 kg/cm, p < 0.0005; women: + 0.8 kg/cm, p = 0.47) and 10 km/h (+ 3.3 kg/cm, p = 0.004; women: + 0.8 kg/cm, p = 0.51) but not at 12 km/h.

Conclusion: In active men, listening to loud music while running results in increased GRF, whereas no effect was observed in women. The lack of music effect in women may be related to structural factors, such as larger hip width-to-femoral length ratio, possibly resulting in different loading patterns. The present preliminary findings introduce high-volume music listening as a new potential risk factor for injury in young runners.
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http://dx.doi.org/10.1007/s00421-020-04371-zDOI Listing
June 2020

Interventional radiotherapy (brachytherapy) for squamous cell carcinoma of the nasal vestibule: a multidisciplinary systematic review.

Eur J Dermatol 2019 Aug;29(4):417-421

Interdisciplinary Brachytherapy Unit, University of Lübeck/UKSH, Lübeck, Germany.

Surgery is the first-line therapy for treatment of cutaneous squamous cell carcinoma (cSCC), and interventional radiotherapy is recommended when surgery is not feasible, contraindicated, or refused by the patient. To provide a multidisciplinary systematic review of the role of interventional radiotherapy for the treatment of cSCC of the nasal vestibule. A systematic search was performed; primary outcomes were tumour local control and overall survival. Acute toxicity, late toxicity, and functional cosmetic results, regardless of the scoring systems used, were secondary outcomes. After full-text review of the 92 papers initially identified, we included only 10 papers in the review; no randomized controlled trials or prospective studies were identified. Five studies reported five-year local control, with rates ranging between 69% and 97%. A high level of heterogeneity was observed regarding the methods used to assess treatment-related toxicity. Interventional radiotherapy may be considered for lesions specifically arising from the area of the nasal vestibule. A multidisciplinary approach might help to select cases that are potential candidates for conservative treatment according to the tumour and the patient's features.
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http://dx.doi.org/10.1684/ejd.2019.3599DOI Listing
August 2019

HPV as a marker for molecular characterization in head and neck oncology: Looking for a standardization of clinical use and of detection method(s) in clinical practice.

Head Neck 2019 04 12;41(4):1104-1111. Epub 2019 Feb 12.

Infections and Cancer Biology Group, International Agency for Research on Cancer, World Health Organization, Lyon, France.

Background: A consensus about the most appropriate diagnostic method(s) for head and neck human papillomavirus (HPV)-induced carcinogenesis is still lacking because most of the commercially available assays have been designed for the cervix.

Methods: This article summarizes current data and trends concerning HPV diagnostic strategies in oropharyngeal squamous cell carcinoma (OPSCC). Six main approaches are described.

Results: The diagnostic gold standard for HPV-related OPSCC, focusing on E6/E7 mRNA detection, requires fresh samples. Because most frequently available samples are formalin-fixed paraffin-embedded (FFPE), the pros and cons of the different approaches were analyzed.

Conclusions: In the FFPE samples, the immunohistochemistry of p16, which is considered appropriate to assess HPV-driven carcinogenesis in OPSCC according to the 8th American Joint Committee on Cancer TNM classification, may not be specific enough to become the diagnostic standard in the perspective of treatment deintensification. p16 may play a safer role in combination with another highly sensible assay. Other promising approaches are based on DNA detection through real-time polymerase chain reaction and RNAscope.
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http://dx.doi.org/10.1002/hed.25591DOI Listing
April 2019

HDR interventional radiotherapy (brachytherapy) in the treatment of primary and recurrent head and neck malignancies.

Head Neck 2019 06 30;41(6):1667-1675. Epub 2019 Jan 30.

Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Roma, Italia.

Background: Interventional radiotherapy (brachytherapy; IRT) reemerged in the last decades as a potentially useful tool in head and neck oncology after a set of clear technical improvements were developed.

Methods: Sixty-one high dose ratio (HDR) IRT treatments were recommended and performed on 58 patients. We classified the cases into four relatively homogeneous groups based on the clinical needs that led to the recommended IRT. Also, we separately evaluated primary and recurrent cases.

Results: Disease-specific survival was significantly different among the four treatment groups. The group with the best prognosis was the cohort treated locally by exclusive interstitial IRT for resectable midface malignancies (2-year relapse-free survival = 82%, disease-specific survival = 89%).

Conclusion: HDR IRT is a valuable tool in well-defined clinical situations and, in particular, in recurrences. In midface malignancies, it could become the preferred primary treatment.
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http://dx.doi.org/10.1002/hed.25646DOI Listing
June 2019

Integrated rehabilitation after total laryngectomy: a pilot trial study.

Support Care Cancer 2019 Sep 26;27(9):3537-3544. Epub 2019 Jan 26.

Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Istituto di Otorinolaringoiatria, L.go F. Vito 1, I-00168, Rome, Italy.

Background: Acquisition and acceptance of the alaryngeal voice, psychological state, and Quality of Life (QoL) of laryngectomized patients.

Methods: Thirty-two patients who underwent total laryngectomy were included in the study; 17 of them were treated by a psychologist and a speech therapist (experimental group); 15 performed only speech therapy (control group).

Results: The experimental group showed a significant improvement in all parameters of the INFVo scale, in the score of the Environment subscale and in the total score of the I-SECEL (Self-Evaluation of Communication Experiences after Laryngeal Cancer); in the Depression, Obsession-Compulsion and Paranoia areas of the SCL-90-R (Symptom Check List-90-Revised); and in the Social area (REL) of the WHOQOL-B (World Health Organization Quality of Life Scale-Brief).

Conclusions: An integrated rehabilitative approach to laryngectomized patients improves emotional state and psychosocial aspects and promotes acceptance and use of the new voice and recovery of a better quality of life.
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http://dx.doi.org/10.1007/s00520-019-4647-1DOI Listing
September 2019

ENT COBRA ONTOLOGY: the covariates classification system proposed by the Head & Neck and Skin GEC-ESTRO Working Group for interdisciplinary standardized data collection in head and neck patient cohorts treated with interventional radiotherapy (brachytherapy).

J Contemp Brachytherapy 2018 Jun 30;10(3):260-266. Epub 2018 Jun 30.

Interdisciplinary Brachytherapy Unit, University of Lübeck - University Hospital S-H, Campus Lübeck, Germany.

Purpose: Clinical data collecting is expensive in terms of time and human resources. Data can be collected in different ways; therefore, performing multicentric research based on previously stored data is often difficult. The primary objective of the ENT COBRA (COnsortium for BRachytherapy data Analysis) ontology is to define a specific terminological system to standardized data collection for head and neck (H&N) cancer patients treated with interventional radiotherapy.

Material And Methods: ENT-COBRA is a consortium for standardized data collection for H&N patients treated with interventional radiotherapy. It is linked to H&N and Skin GEC-ESTRO Working Group and includes 11 centers from 6 countries. Its ontology was firstly defined by a multicentric working group, then evaluated by the consortium followed by a multi-professional technical commission involving a mathematician, an engineer, a physician with experience in data storage, a programmer, and a software expert.

Results: Two hundred and forty variables were defined on 13 input forms. There are 3 levels, each offering a specific type of analysis: 1. Registry level (epidemiology analysis); 2. Procedures level (standard oncology analysis); 3. Research level (radiomics analysis). The ontology was approved by the consortium and technical commission; an ad-hoc software architecture ("broker") remaps the data present in already existing storage systems of the various centers according to the shared terminology system. The first data sharing was successfully performed using COBRA software and the ENT COBRA Ontology, automatically collecting data directly from 3 different hospital databases (Lübeck, Navarra, and Rome) in November 2017.

Conclusions: The COBRA Ontology is a good response to the multi-dimensional criticalities of data collection, retrieval, and usability. It allows to create a software for large multicentric databases with implementation of specific remapping functions wherever necessary. This approach is well-received by all involved parties, primarily because it does not change a single center's storing technologies, procedures, and habits.
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http://dx.doi.org/10.5114/jcb.2018.76982DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6052377PMC
June 2018

Perioperative HDR brachytherapy for reirradiation in head and neck recurrences: single-institution experience and systematic review.

Tumori 2017 Nov 8;103(6):516-524. Epub 2017 Mar 8.

Department of Radiation Oncology, Catholic University, Rome - Italy.

Aim: The aim of our study was to evaluate the outcomes of patients reirradiated with high-dose-rate (HDR) intensity-modulated brachytherapy (IMBT) for recurrent head and neck cancer and to perform a systematic review of the literature.

Materials And Methods: Patients treated with prior radiation doses >65 Gy were considered. After resection of macroscopic disease, catheters were fixed to the tumor bed. The total dose was 30 Gy in 12 fractions of 2.5 Gy twice daily for 5 days a week. A systematic literature search was conducted through several electronic databases including Medline/PubMed, Scopus, Embase and the Cochrane library.

Results: Seventeen patients were included; median overall survival was 19 months with a median local control interval of 15 months. Median follow-up was 36 months. Seven papers were considered for the review.

Conclusions: IMBT could play an important role in the retreatment of recurrent head and neck cancer.
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http://dx.doi.org/10.5301/tj.5000614DOI Listing
November 2017

Minichromosome maintenance protein 7 and geminin expression: Prognostic value in laryngeal squamous cell carcinoma in patients treated with radiotherapy and cetuximab.

Head Neck 2017 04 29;39(4):684-693. Epub 2016 Dec 29.

Institute of Histology, Catholic University of Sacred Heart, Rome, Italy.

Background: Minichromosome maintenance protein 7 (MCM7) is a downstream of human epidermal growth receptor (HER1) signaling. We examined MCM7, geminin, and HER1 expression in patients with laryngeal squamous cell carcinoma (SCC) treated with radiotherapy and cetuximab.

Methods: MCM7, geminin, and HER1 were evaluated by immunohistochemistry on 61 patients with laryngeal SCC. The follow-up (median, 32.1 months; range, 2-139 months) went from the beginning of therapy to tumor progression-free survival (PFS) and death (overall survival [OS]).

Results: MCM7, but not geminin, was associated only with HER1 expression, whereas no association was found with other clinicopathological characteristics. Patients with MCM7 high - geminin high and MCM7 high - geminin low tumor status had a risk of progression 3.1 times and 17.7 times greater, respectively, than patients with MCM7 low - geminin high tumor status. Tumor site, MCM7, and geminin were independent determinants of PFS, whereas MCM7 was an independent prognostic marker of OS.

Conclusion: MCM7-geminin tumor status may be prognostic for patients with laryngeal SCC treated with cetuximab and radiotherapy. © 2016 Wiley Periodicals, Inc. Head Neck 39: 684-693, 2017.
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http://dx.doi.org/10.1002/hed.24670DOI Listing
April 2017

Prevalence of HPV Infection in Racial-Ethnic Subgroups of Head and Neck Cancer Patients.

Carcinogenesis 2017 02 26;38(2):218-229. Epub 2016 Dec 26.

Department of Otorhinolaryngology-Head and Neck Surgery, GROW Institute, Maastricht University Medical Centre, Maastricht, The Netherlands.

The landscape of HPV infection in racial/ethnic subgroups of head and neck cancer (HNC) patients has not been evaluated carefully. In this study, a meta-analysis examined the prevalence of HPV in HNC patients of African ancestry. Additionally, a pooled analysis of subject-level data was also performed to investigate HPV prevalence and patterns of p16 (CDNK2A) expression amongst different racial groups. Eighteen publications (N = 798 Black HNC patients) were examined in the meta-analysis, and the pooled analysis included 29 datasets comprised of 3,129 HNC patients of diverse racial/ethnic background. The meta-analysis revealed that the prevalence of HPV16 was higher among Blacks with oropharyngeal cancer than Blacks with non-oropharyngeal cancer. However, there was great heterogeneity observed among studies (Q test P<0.0001). In the pooled analysis, after adjusting for each study, year of diagnosis, age, gender and smoking status, the prevalence of HPV16/18 in oropharyngeal cancer patients was highest in Whites (61.1%), followed by 58.0% in Blacks and 25.2% in Asians (P<0.0001). There was no statistically significant difference in HPV16/18 prevalence in non-oropharyngeal cancer by race (P=0.682). With regard to the pattern of HPV16/18 status and p16 expression, White patients had the highest proportion of HPV16/18+/p16+ oropharyngeal cancer (52.3%), while Asians and Blacks had significantly lower proportions (23.0% and 22.6%, respectively) [P <0.0001]. Our findings suggest that the pattern of HPV16/18 status and p16 expression in oropharyngeal cancer appears to differ by race and this may contribute to survival disparities.
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http://dx.doi.org/10.1093/carcin/bgw203DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7191086PMC
February 2017

Comparison of interstitial brachytherapy and surgery as primary treatments for nasal vestibule carcinomas.

Laryngoscope 2016 Feb 15;126(2):367-71. Epub 2015 Sep 15.

Institute of Otolaryngology, Catholic University of the Sacred Heart, Agostino Gemelli Polyclinic, Rome, Italy.

Objectives/hypothesis: Squamous cell carcinoma arising from the nasal vestibule is a rare condition accounting for about 1% of head and neck malignancies with several peculiarities concerning both staging and treatment. The aim of this study was to compare the oncological and functional results of two different treatment modalities for the primary site: surgery and brachytherapy.

Study Design: A case series with the comparison of two different treatment modalities.

Methods: We evaluate clinical and survival data of 12 untreated patients, enrolled by a multidisciplinary tumor board, comparing oncological, functional, and esthetic results after surgery or after interstitial brachytherapy as exclusive treatments for the primary site. The functional and esthetic outcome was subjectively rated by the patients using a five-point scale.

Results: Locoregional control and survival are not significantly different between patients primarily treated by surgery and by brachytherapy. The functional and esthetic outcome, as assessed by the degree of satisfaction of the patients, is significantly better after primary brachytherapy than after primary surgery (P = .014).

Conclusions: In our experience brachytherapy, accomplished in close cooperation between surgeons and radiation oncologists, achieves oncological results that are not different from surgery, but with a higher degree of patient satisfaction, mainly due to the esthetic outcome.

Level Of Evidence: 4.
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http://dx.doi.org/10.1002/lary.25498DOI Listing
February 2016

HPV and EBV Infections in Neck Metastases from Occult Primary Squamous Cell Carcinoma: Another Virus-Related Neoplastic Disease in the Head and Neck Region.

Ann Surg Oncol 2015 Dec 19;22 Suppl 3:S979-84. Epub 2015 Aug 19.

Institute of Otolaryngology, Università Cattolica del Sacro Cuore, Rome, Italy.

Background: Approximately 1-9 % of all head and neck squamous cell carcinomas are neck metastases from clinically undetectable primary tumors. Human papillomavirus (HPV) and Epstein-Barr virus (EBV) are proven carcinogenic factors that are associated with oropharyngeal squamous cell carcinoma and nasopharyngeal carcinoma, respectively. In the present study, we evaluated the prevalence of these viruses in neck metastases from unknown primary squamous cell carcinoma.

Methods: We evaluated fresh samples from a consecutive series of 22 neck dissections for metastases from unknown primary squamous cell carcinoma obtained between 2010 and 2012 at a single institution. The samples were tested for the presence of HPV E6 and E7 mRNA and EBV DNA.

Results: Oncogenic viral infections were detected in 12 cases (54 % total; 2 HPV18, 5 HPV16, 2 EBV infection, and 3 EBV/HPV16 coinfections). The most frequent primarily involved neck level in our series was IIA (70 %), which had the highest prevalence of viral infection (66 %). We did not find any other significant correlations between virus detection and clinicopathologic parameters or prognosis.

Discussion: Neck metastasis from unknown primary squamous cell carcinoma could be another virus-related malignancy in the head and neck region, along with nasopharyngeal and oropharyngeal carcinoma. An evaluation of the impact of viral infection on patient prognosis and sensitivities to different treatment modalities could modify our prognostic assessments and treatment planning. Furthermore, virus detection would have a decisive impact on diagnostic/decisional algorithms, especially if detection methods are implemented on cytologic samples (e.g., thin prep).
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http://dx.doi.org/10.1245/s10434-015-4808-5DOI Listing
December 2015

Evaluation of swallowing function after supracricoid laryngectomy as a primary or salvage procedure.

Dysphagia 2015 Dec 13;30(6):686-94. Epub 2015 Aug 13.

Institute of Otolaryngology, Università Cattolica del S. Cuore, Rome, Italy.

The primary functional issues following conservative therapy for advanced laryngeal cancer concern swallowing. Here, we evaluated the recovery of swallowing after supracricoid partial laryngectomy (SCL) in patients with primary or recurrent laryngeal cancer. We evaluated the swallowing recovery in 27 SCL patients through oropharyngoesophageal scintigraphy, and we evaluated their quality of life using EORTC questionnaires. Four patients underwent total laryngectomy during follow-up. Patients who retained their larynges were able to feed without nutritional support and without tracheostoma. The only significantly different parameter between the primary and salvage cases was the time elapsed to the removal of nasogastric/PEG tubes, which was longer in salvage cases. SCL has been demonstrated as a valuable option for primary and recurrent laryngeal cancer patients. The present data demonstrate good functional results, particularly in terms of swallowing after previous treatments and in primary settings. The combination of oropharyngoesophageal scintigraphy and questionnaires appears to be an adequate, standardizable approach to assessing swallowing function after SCL.
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http://dx.doi.org/10.1007/s00455-015-9645-yDOI Listing
December 2015