Recent Advances in Diagnosis, Treatment and Observation in Otorhinolaryngology

A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Personalized Therapy and Drug Delivery".

Deadline for manuscript submissions: closed (1 October 2023) | Viewed by 13703

Special Issue Editor


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Guest Editor
1. Humanitas Clinical and Research Center, IRCCS, Rozzano, 20089 Milan, Italy
2. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20089 Milan, Italy
3. Humanitas San Pio X, Via Francesco Nava 31, 20159 Milan, Italy
Interests: rhinology; otorhinolaryngology; biologics; immunology; allergology; pneumology

Special Issue Information

Dear Colleagues,

Since the 1980s, the field of otorhinolaryngology has benefited from constant technological developments. Diagnostic pathways have been refined thanks to radiological advances and the increasing use of MRI scans. Optical fibers with chip-on-tip cameras combined with light filters favor early detection of oncological lesions. Moreover, advances in the field of immunology have brought changes to the clinical and therapeutical approaches applied in head and neck oncology as well as that part of ENT that deals mainly with functional disorders; a clear example is the recent introduction of monoclonal antibodies in the treatment of chronic rhinosinusitis with nasal polyps.

Surgery-wise, developments in otorhinolaryngology have been significant. Innovative approaches to the lateral cranial fossa and new devices have been developed for treating hearing loss. Likewise, advances in endoscopy have allowed a conceptual change in the gold-standard approach to sinonasal inflammatory disease, which has played an increasingly important role in the management of benign and malignant pathology. Indeed, similar to what happened with laryngeal laser surgery over time, not only did the endoscopic approach debunk the myth of en-bloc resection in favor of piecemeal resection in sinonasal oncology; it also exceeded the boundaries of the nose. Various approaches have been established to control disease in the anterior skull base, in the lacrimal fossa and the orbital content laterally, and from the apex of the orbit to the middle cranial fossa; additionally, further posterior approaches have allowed us to reach the pterygomaxillary and infratemporal fossas, the pituitary gland, the clivus and the tooth of the epistropheus, and posterolaterally the cavernous sinus and the first cranial nerves.

Advances have been seen in laryngeal surgery as well, drastically transforming its therapeutic pathways, from unfortunate mutilating surgeries (with total laryngectomies) to organ preservation surgeries, currently carried out with CO2 lasers—thanks to the insights of Dr. W. Steiner—and so-called open partial horizontal laryngectomies (OPHLs).

While oncological procedures have changed, so too has functional surgery, with the implementation of small yet relevant devices. One example is seen in snoring and sleep apnea surgery, which saw a huge conceptual revolution and achieved minimal invasiveness with the introduction of barbed sutures.

Finally, it is very likely that artificial intelligence will transform our clinical approaches in the near future, offering predictive models of pathology as well as assisting clinicians in remote disease monitoring while saving on one of the most precious assets in this era: time!

The aim of this Special Issue is to promote modernity and innovation in otorhinolaryngology. In an era marked by technology that is enormously helpful in our daily lives yet still at times inefficiently applied in the medical field, defining its role is fundamental to optimize its application. Furthermore, we must not forget the humanistic aspect of medical science, which is essential and cannot be replaced by technology.

The rational pragmatism of considering technology an advantage ought to be combined with the necessary communication skills and the desire to always place the patient at the center of our clinical pathways. Besides focusing on the best processes of diagnosis, treatment, and follow-up, I invite you to predict, describe, and present innovative procedures for the good of our patients and draw on possible inferences for the near future.

I look forward to collaborating with you all!

Dr. Luca Malvezzi
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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Keywords

  • otology

  • rhinology
  • head and neck
  • OSAS
  • laser surgery
  • diagnosis in otorhinolaryngoly
  • biological therapy
  • evolution in ENT surgery
  • sleep disorders
  • artificial intelligence
  • nasal polyps
  • CRS
  • laryngeal cancer
  • audiology
  • hearing loss
  • medical counseling

Published Papers (9 papers)

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Research

13 pages, 2054 KiB  
Article
Real-Life Effects of Omalizumab on Chronic Rhinosinusitis with Nasal Polyposis
by Nicola Lombardo, Giovanna Lucia Piazzetta, Nadia Lobello, Giuseppe Cicala, Maria Patafi, Anna Teresa Benincasa, Corrado Pelaia, Emanuela Chiarella and Girolamo Pelaia
J. Pers. Med. 2024, 14(1), 3; https://doi.org/10.3390/jpm14010003 - 19 Dec 2023
Viewed by 1050
Abstract
Chronic rhinosinusitis with nasal polyposis (CRSwNP) is an inflammatory disease of the nasal and sinus mucosa. This inflammatory process is supported by a multitude of cytokines, including IL-4, IL-5, and IL-13 produced by Th2 cells, as well as by IgE produced by B [...] Read more.
Chronic rhinosinusitis with nasal polyposis (CRSwNP) is an inflammatory disease of the nasal and sinus mucosa. This inflammatory process is supported by a multitude of cytokines, including IL-4, IL-5, and IL-13 produced by Th2 cells, as well as by IgE produced by B lymphocytes in response to a stimulus. Omalizumab is an anti-IgE monoclonal antibody with well-recognized roles in allergic asthma and chronic spontaneous urticaria. The aim of this study was to evaluate the clinical efficacy of omalizumab in a cohort of 13 patients suffering from chronic rhinosinusitis with CRSwNP. The inclusion criteria considered were as follows: 18 years of age, with a diagnosis of chronic rhinosinusitis with severe nasal polyposis expressed by an NPS greater than or equal to 5 and/or a SNOT-22 greater than or equal to 50. In addition, in the enrolled patients, the classic treatment with corticosteroids had to have been suspended due to recurrence after surgery or lack of response. Our results highlighted that omalizumab treatment for 16 weeks improved the parameters analyzed: SNOT-22, NPS, NRS, and NCS. The clinical efficacy of omalizumab was further strengthened by a significant improvement in respiratory function as well as reductions in the nasal polyps’ size and in the associated symptoms. Full article
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13 pages, 2325 KiB  
Article
Targeting IL-4 and IL-13 Receptors on Eosinophils in CRSwNP Patients: The Clinical Efficacy of Dupilumab
by Giovanna Lucia Piazzetta, Nadia Lobello, Emanuela Chiarella, Alberta Rizzuti, Corrado Pelaia, Girolamo Pelaia and Nicola Lombardo
J. Pers. Med. 2023, 13(9), 1404; https://doi.org/10.3390/jpm13091404 - 19 Sep 2023
Cited by 2 | Viewed by 1283
Abstract
Chronic rhinosinusitis with nasal polyposis (CRSwNP) is an inflammatory disease linked to type 2 inflammation. Several biologics have demonstrated therapeutic potential for the treatment of this pathology in which IL-4, IL-5 and IL-13 represent the major cytokines involved in the control of eosinophilic [...] Read more.
Chronic rhinosinusitis with nasal polyposis (CRSwNP) is an inflammatory disease linked to type 2 inflammation. Several biologics have demonstrated therapeutic potential for the treatment of this pathology in which IL-4, IL-5 and IL-13 represent the major cytokines involved in the control of eosinophilic respiratory inflammation. 25% of CRSwNP patients relapse after the use of oral glucocorticoids or after surgery and often require several surgeries during their lifetime. In our study we enrolled 14 patients, 11 male and 3 female. The inclusion criteria were: age ≥ 18 years; confirmed diagnosis of chronic rhinosinusitis with severe nasal polyposis; disease severity with NPS Nasal Polyposis Endoscopic Score total score ≥ 5 and/or SNOT-22 ≥ 50; previous treatment failure due to lack of efficacy or discontinuation of systemic corticosteroid therapy and/or non-response or recurrence following surgery. The results presented in this study showed the ability of Dupilumab to improve all the parameters analysed. In particular, statistically significant data were obtained for NPS, SNOT-22, NRS, and IgE in patients exposed to Dupilumab treatment for 24 weeks, highlighting the ability of Dupilumab to produce clinical benefit in CRWwNP patients. In light of these data, the administration of dupilumab every two weeks represents a valid clinical strategy that ENT specialists can adopt for the treatment of adults with inadequately controlled CRSwNP. Full article
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6 pages, 1087 KiB  
Communication
A New Lighting System for Surgical Vision Optimization in Barbed Pharyngoplasty for OSA
by Lorenzo Sabatino, Antonio Moffa, Francesco Iafrati, Simone Di Giovanni, Luigi De Benedetto, Lucrezia Giorgi, Peter Baptista, Claudio Vicini, Andrea De Vito and Manuele Casale
J. Pers. Med. 2023, 13(9), 1320; https://doi.org/10.3390/jpm13091320 - 28 Aug 2023
Viewed by 736
Abstract
Obstructive sleep apnea (OSA) surgery is now a viable solution in selected patients and the “remodeling” palatopharyngeal surgery is the most common one. Recently, it has become less invasive with the introduction of barbed sutures (BS). An optimization of surgical techniques is represented [...] Read more.
Obstructive sleep apnea (OSA) surgery is now a viable solution in selected patients and the “remodeling” palatopharyngeal surgery is the most common one. Recently, it has become less invasive with the introduction of barbed sutures (BS). An optimization of surgical techniques is represented by barbed pharyngoplasty (BP), which requires surgical precision and needs efficient and precise oropharyngeal visualization. Consequently, the lighting system is of pivotal importance in BP. The aim of this work is to describe the first experience on the use of a new lighting system, called KLAROTM in BP for OSA. We evaluated the KLARO™ system in 15 consecutives BP for OSA in comparison with conventional headlamp illumination. The visualization of palatopharyngeal muscle in the bottom of the tonsillar fossa, entry and exit needle, such as needle tip, were statistically better with KLAROTM than headlamp illumination for both the surgeon and resident (p < 0.05). No significant differences for the visualization of the posterior pharyngeal wall and uvula were reported. The KLAROTM lighting system allows a satisfied illumination of oral cavity and oropharynx in the majority of cases. We encourage the use of KLAROTM not only in BP for OSA, but in all oral and pharyngeal surgeries, including tonsillectomy and oncological surgery. Full article
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9 pages, 3644 KiB  
Communication
Potential Use of Vivascope for Real-Time Histological Evaluation in Endoscopic Laryngeal Surgery
by Luigi De Benedetto, Antonio Moffa, Peter Baptista, Simone Di Giovanni, Lucrezia Giorgi, Martina Verri, Chiara Taffon, Anna Crescenzi and Manuele Casale
J. Pers. Med. 2023, 13(8), 1252; https://doi.org/10.3390/jpm13081252 - 12 Aug 2023
Viewed by 834
Abstract
We aimed to assess the feasibility of using confocal laser scanning microscopy (CLSM) for the real-time ex vivo examination of histological samples of laryngeal lesions and to evaluate the correlation between CLSM and definitive histological results. This preliminary study included eight consecutive patients [...] Read more.
We aimed to assess the feasibility of using confocal laser scanning microscopy (CLSM) for the real-time ex vivo examination of histological samples of laryngeal lesions and to evaluate the correlation between CLSM and definitive histological results. This preliminary study included eight consecutive patients with “suspected” laryngeal lesions who were candidates for endoscopic laryngeal surgery. The obtained samples were evaluated using CLSM and classified as “inadequate” or “adequate” (high- and low-grade dysplasia, in situ and invasive carcinoma, positive surgical margin, and inflammatory outbreaks). CLSM showed the macro image in all cases and generated a digital version. All the samples were defined as adequate during CLSM and confirmed at histopathology: low-grade dysplasia (n = 5), low- and high-grade dysplasia (n = 2), and high-grade dysplasia (n = 1). Four samples had an involved resection margin, and three samples revealed the presence of inflammatory outbreaks. CLSM can be applied to larynx pathology with excellent agreement with final histological results. Full article
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14 pages, 2151 KiB  
Article
Randomized Clinical Trial to Evaluate the Efficacy and Tolerability of Nebulized Hyaluronic Acid and Xylitol Based Solution after Septoturbinoplasty
by Peter Baptista, Antonio Moffa, Lucrezia Giorgi and Manuele Casale
J. Pers. Med. 2023, 13(7), 1160; https://doi.org/10.3390/jpm13071160 - 20 Jul 2023
Viewed by 1235
Abstract
Septoplasty and turbinate surgery are among the most frequent surgical procedures to improve nasal obstruction and quality of life. These procedures usually imply the presence of congestion, secretions, and crusting related to the movement of the instruments during surgery. However, the use of [...] Read more.
Septoplasty and turbinate surgery are among the most frequent surgical procedures to improve nasal obstruction and quality of life. These procedures usually imply the presence of congestion, secretions, and crusting related to the movement of the instruments during surgery. However, the use of nasal lavage may reduce this situation. The addition of Hyaluronic acid or Xylitol offers advantages in these washes. This study was a randomized, double-blind, controlled trial. All patients underwent endoscopic septoplasty with inferior turbinate submucosal resection without posterior nasal packing. SNOT-22, main VAS, NOSE, Modified Lund-Kennedy endoscopic scale, number of crusts and adhesions were quantified before and on the day of the surgery, visit three (seven days), visit four (fourteen days), and visit five (twenty-eight days). Forty-seven patients completed the study, divided into a standard saline arm (group 1, 22 patients) and normal saline plus HA and Xylitol arm (group 2, 27 patients). Both treatment groups improved their quality of life and objective parameters during the four weeks of the study. All patients tolerated the nasal irrigations well, and none discontinued the treatments. The study concludes that nasal washes of Aluneb Isotónico® offer several benefits to patients as a protective and preventative agent. Full article
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10 pages, 252 KiB  
Article
Endotypes of Nasal Polyps in Children: A Multidisciplinary Approach
by Emanuela Sitzia, Sara Santarsiero, Giulia Marini, Fabio Majo, Marcello De Vincentiis, Giovanni Cristalli, Maria Cristina Artesani and Alessandro Giovanni Fiocchi
J. Pers. Med. 2023, 13(5), 707; https://doi.org/10.3390/jpm13050707 - 23 Apr 2023
Cited by 1 | Viewed by 1345
Abstract
Nasal polyps (NPs) are rarely reported in childhood and usually represent red flags for systemic diseases, such as cystic fibrosis (CF), primary ciliary dyskinesia (PCD) and immunodeficiencies. The European Position Paper released in 2020 (EPOS 2020) provided a detailed classification and defined the [...] Read more.
Nasal polyps (NPs) are rarely reported in childhood and usually represent red flags for systemic diseases, such as cystic fibrosis (CF), primary ciliary dyskinesia (PCD) and immunodeficiencies. The European Position Paper released in 2020 (EPOS 2020) provided a detailed classification and defined the correct diagnostic and therapeutic approaches. We report a one-year experience of a multidisciplinary team, made up of otorhinolaryngologists, allergists, pediatricians, pneumologists and geneticists, with the aim of ensuring a personalized diagnostic and therapeutic management of the pathology. In 16 months of activity, 53 patients were admitted (25 children with chronic rhinosinusitis with polyposis and 28 with antro-choanal polyp). All patients underwent phenotypic and endo-typic assessment, using proper classification tools for nasal pathology (both endoscopic and radiological), as well as adequate cytological definition. An immuno–allergic evaluation was carried out. Pneumologists evaluated any lower airway respiratory disease. Genetic investigations concluded the diagnostic investigation. Our experience enhanced the complexity of children’s NPs. A multidisciplinary assessment is mandatory for a targeted diagnostic and therapeutic pathway. Full article
9 pages, 897 KiB  
Communication
A New Treatment Option in Incomplete Partition Type III: The Varese Bone–Air Stimulation (B.A.S.)
by Flavia Di Maro, Vittoria Sykopetrites, Annalisa Meli, Davide Cocozza, Greta Albanese, Maria Teresa Antonietta Miccoli, Annalisa De Candia, Mario Picozzi, Francesca Greco and Eliana Cristofari
J. Pers. Med. 2023, 13(4), 681; https://doi.org/10.3390/jpm13040681 - 19 Apr 2023
Cited by 1 | Viewed by 1389
Abstract
The incomplete partition type III is a severe cochlear malformation present in X-linked deafness. It is a rare, non-syndromic cause of severe to profound mixed hearing loss, often progressive. The complete absence of bony modiolus and the wide communication between the cochlea and [...] Read more.
The incomplete partition type III is a severe cochlear malformation present in X-linked deafness. It is a rare, non-syndromic cause of severe to profound mixed hearing loss, often progressive. The complete absence of bony modiolus and the wide communication between the cochlea and the internal auditory canal make cochlear implantation challenging, with still no consensus on the management of these patients. To the best of our knowledge, no results have ever been published in the literature on the treatment of these patients with hybrid stimulation (bone and air). We present three cases in which this hybrid stimulation gave better audiological results then air stimulation alone. A literature review on audiological results of the current treatment options in children affected by IPIII malformation was conducted independently by two researchers. Ethical considerations on the treatment of these patients were conducted by the Bioethics department of the University of Insubria. In two of the patients, the bone–air stimulation, associated with prosthetic–cognitive rehabilitation, meant that surgery was avoided, obtaining similar communication performances of those present in the literature. We believe that, when the bone threshold appears partially preserved, a stimulation through the bone or hybrid modality, such as the Varese B.A.S. stimulation, should be attempted. Full article
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13 pages, 1057 KiB  
Article
Care for Patients with Type-2 Chronic Rhinosinusitis
by Gianmarco Giunta, Francesca Pirola, Francesco Giombi, Giovanna Muci, Gian Marco Pace, Enrico Heffler, Giovanni Paoletti, Francesca Puggioni, Michele Cerasuolo, Fabio Ferreli, Fabrizio Salamanca, Giuseppe Mercante, Giuseppe Spriano, Giorgio Walter Canonica and Luca Malvezzi
J. Pers. Med. 2023, 13(4), 618; https://doi.org/10.3390/jpm13040618 - 31 Mar 2023
Cited by 6 | Viewed by 2154
Abstract
In the last 20 years, growing interest in chronic rhinosinusitis (CRS) has become evident in medical literature; nevertheless, it is still difficult to identify the real prevalence of the disease. Epidemiological studies are few and focused on heterogeneous populations and diagnostic methods. Recent [...] Read more.
In the last 20 years, growing interest in chronic rhinosinusitis (CRS) has become evident in medical literature; nevertheless, it is still difficult to identify the real prevalence of the disease. Epidemiological studies are few and focused on heterogeneous populations and diagnostic methods. Recent research has contributed to identifying CRS as a disease characterized by heterogeneous clinical scenarios, high impact on quality of life, and elevated social costs. Patient stratification with phenotypes and identification of the pathobiological mechanism at the origin of the disease (endotype) and its comorbidities are pivotal in the diagnostic process, and they should be addressed in order to properly tailor treatment. A multidisciplinary approach, shared diagnostic and therapeutic data, and follow-up processes are therefore necessary. Oncological multidisciplinary boards offer models to imitate in accordance with the principles of precision medicine: tracing a diagnostic pathway with the purpose of identifying the patient’s immunological profile, monitoring therapeutical processes, abstaining from having only a single specialist involved in treatment, and placing the patient at the center of the therapeutic plan. Awareness and participation from the patient’s perspective are fundamental steps to optimize the clinical course, improve quality of life, and reduce the socioeconomic burden. Full article
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14 pages, 1864 KiB  
Article
Use, Abuse, and Misuse of Nasal Medications: Real-Life Survey on Community Pharmacist’s Perceptions
by Elena Russo, Francesco Giombi, Giovanni Paoletti, Enrico Heffler, Giorgio Walter Canonica, Francesca Pirola, Giuseppe Mercante, Giuseppe Spriano, Luca Malvezzi, Enrico Keber, SGCP and Corrado Giua
J. Pers. Med. 2023, 13(4), 579; https://doi.org/10.3390/jpm13040579 - 26 Mar 2023
Cited by 2 | Viewed by 2677
Abstract
Background: Medication overuse is an increasing global problem, especially for those rhinology diseases whose management requires over-the-counter drugs. This observational community pharmacy-based study aimed to investigate the actual use of the best-selling topical nasal medications and to characterize the clinical issues underlying their [...] Read more.
Background: Medication overuse is an increasing global problem, especially for those rhinology diseases whose management requires over-the-counter drugs. This observational community pharmacy-based study aimed to investigate the actual use of the best-selling topical nasal medications and to characterize the clinical issues underlying their query through the pharmacist’s perception. Methods: In the pilot phase, a preliminary survey was developed by a team of researchers and tested on a small sample of practitioners to assess usability and intelligibility. Eventual amendments were made according to the feedback obtained, and the final version was submitted to practitioners working in 376 pharmacies evenly distributed over the Italian territory. Results: Two groups of customers (18–30 years old and 60–75 years old) were the ones who most frequently purchased topical decongestants. The dosage applied for sympathomimetic amines was higher than recommended in up to 44.4% and the duration of use longer than 5 days in up to 31.9% of the cases. Patients’ queries of alpha agonists and topical corticosteroids resulted in significantly higher numbers than practitioners’ prescriptions. Allergic rhinitis was the most common disease affecting patients seeking sympathomimetic amines. Conclusions: The prolonged use of sympathomimetic amines in patients suffering from rhinology diseases is a significant problem that requires greater attention in terms of social education and surveillance. Full article
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