Three-dimensional exoscope-assisted laser stapedotomy: a preliminary experience.

PURPOSE: Stapes surgery, despite the introduction of lasers and endoscopes, still represents a challenging procedure. Recently introduced 3-dimensional exoscopes have known advantages in otological surgery. This study aims to evaluate exoscopes role in stapes surgery, both from a surgical perspective and on the educational profile. METHODS: Seven consecutive otosclerosis patients underwent single-sided endaural laser stapedotomy with a 4K 3-dimensional exoscope. The surgical setting allowed all operating room personnel 3-dimensional vision. Pre- and postoperative pure tone audiometry and air-bone gaps, and information on the postoperative course and complications were systematically collected. An informal ergonomic evaluation was carried out by the operating room personnel and an informal didactic evaluation was provided by the trainees. A comparable group of microscope-assisted stapedotomy patients undergoing the same procedures and evaluations was chosen as a control group. RESULTS: Outcomes were solid in all patients, median air-bone gap decreased from 26.5 to 10 dB at the 3-month evaluation (p = 0.01, Wilcoxon's test). No vertigo, tinnitus, or facial palsy was reported. The median operating time was 40 min. The compact design and configuration of the exoscope allowed more practical management of the operating theater. All personnel had the chance for a better understanding of the procedure and trainees felt more confident when asked to identify surgical landmarks and procedure steps. Audiological outcomes, operative times, and complication rates were not different between study and control groups. CONCLUSION: Though further validation and systematic comparison with microscope- and endoscope-assisted stapedotomy are required, the exoscope proved a safe, practical, and educational tool.

Reliability and validity of the Italian Eating Assessment Tool.

OBJECTIVES: We sought to evaluate the reliability and validity of the Italian EAT-10 (Italian Eating Assessment Tool; I-EAT-10). METHODS: The study consisted of 4 phases: item generation, internal consistency and reliability analysis, normative data generation, and validity analysis. Discussion of the EAT-10 with 30 patients and its back-translation were accomplished. The recruited population included 172 patients (40 with dysphonia and 132 with dysphagia) and 269 asymptomatic subjects for testing of internal consistency, and 94 patients with dysphagia and 158 asymptomatic subjects for test-retest reliability analysis. Normative data were gathered from the 269 subjects. The scores of patients and asymptomatic subjects were compared. The I-EAT-10 and flexible endoscopic evaluation of swallowing (FEES) scores in 94 patients were correlated. The I-EAT-10 scores made before and after successful swallowing rehabilitation in 38 patients were compared. RESULTS: Excellent internal consistency (Cronbach's alpha values of 0.90 and 0.93) and strong test-retest reliability (intraclass correlation coefficients of 0.95 and 0.98) were found in patients and asymptomatic subjects. The I-EAT-10 mean (+/- SD) score of the normal cohort was 0.6 +/- 1.1. The asymptomatic subjects and dysphonic patients scored lower than the dysphagic patients on the Kruskal-Wallis test (p = 0.001). The I-EAT-10 and FEES scores were mildly correlated. The mean I-EAT-10 score improved from 9.8 +/- 10.3 to 5.8 +/- 6.7 after swallowing rehabilitation (p = 0.04). CONCLUSIONS: The I-EAT-10 is a reliable, valid, symptom-specific outcome tool.

Reliability and validity of the Italian nose obstruction symptom evaluation (I-NOSE) scale.

The NOSE scale is a questionnaire assessing QOL related with nasal obstruction. The aim of this study was to culturally adapt the NOSE scale into Italian (I-NOSE). Prospective instrument validation study. Cross-cultural adaptation and validation were accomplished. Cronbach α was used to test internal consistency in 116 patients complaining nasal obstruction and 232 asymptomatic subjects. Pearson and ICC tests were used for test-retest reliability analysis. Normative data were gathered from the 232 asymptomatic subjects. Mann-Whitney test was used to compare the I-NOSE scores in patients and asymptomatic subjects and in 40 patients before and after septoplasty. I-NOSE scores obtained in 60 patients were correlated with rhinomanometric results and with the score of a visual analog scale (VAS) measuring the subjective sensation of nasal obstruction. Good internal consistency and good test-retest reliability were found. I-NOSE mean score of the normal cohort was 12.1 ± 13.2. Asymptomatic subjects scored lower than patients with nasal obstruction (p = 0.001). Positive correlations between I-NOSE scores and VAS and rhinomanometric results were found. The mean I-NOSE score improved from 64.4 ± 23.6 to 22.1 ± 13.5 after septoplasty (p < 0.001). The I-NOSE scale is a reliable, valid, self-administered, symptom-specific questionnaire; its application is recommended.

Multidimensional assessment of vocal changes in benign vocal fold lesions after voice therapy.

OBJECTIVE: To evaluate through a multidimensional protocol voice changes after voice therapy in patients with benign vocal fold lesions. METHODS: 65 consecutive patients affected by benign vocal fold lesions were enrolled. Depending on videolaryngostroboscopy the patients were divided into 3 groups: 23 patients with Reinke's oedema, 22 patients with vocal fold cysts and 20 patients with gelatinous polyp. Each subject received 10 voice therapy sessions and was evaluated, before and after voice therapy, through a multidimensional protocol including videolaryngostroboscopy, perception, acoustics, aerodynamics and self-rating by the patient. Data were compared using Wilcoxon signed-rank test. Kruskal-Wallis test was used to analyse the mean variation difference between the three groups of patients. Mann-Whitney test was used for post hoc analysis. RESULTS: Only in 11 cases videolaryngostroboscopy revealed an improvement of the initial pathology. However a significant improvement was observed in perceptual, acoustic and self-assessment ratings in the 3 groups of patients. In particular the parameters of G, R and A of the GIRBAS scale, and the noise to harmonic ratio, Jitter and shimmer scores improved after rehabilitation. A significant improvement of all the parameters of Voice Handicap Index after rehabilitation treatment was found. No significant difference among the three groups of patients was visible, except for self-assessment ratings. CONCLUSION: Voice therapy may provide a significant improvement in perceptual, acoustic and self-assessed voice quality in patients with benign glottal lesions. Utilization of voice therapy may allow some patients to avoid surgical intervention.