Paediatric tonsillectomy: radiofrequency-based plasma dissection compared to cold dissection with sutures.

Aim of this study was to compare post-operative recovery over 14 days in children submitted to tonsillectomy using a bipolar radiofrequency-based plasma device (Coblation, Evac 70, ArthroCare Corp, Sunnyvale, CA, USA) to cold dissection. Paediatric patients (n = 42) aged 5-16 years old with chronic tonsillitis underwent tonsillectomy using cold dissection with suture ligatures or a plasma device (Evac 70, ArthroCare Corp, Sunnyvale, CA, USA). Pain intensity on the first day, use of analgesics, type of diet, and days of pain, fever, nausea, and absence from school were determined. Groups were compared using time-to-event (Kaplan-Meier) curves and statistically evaluated using the Breslow (generalized Wilcoxon) test. Children undergoing plasma tonsillectomy reported significantly less pain on the first post-operative day (1.2 +/- 0.9 vs. 3.5 +/- 1.5, p < 0.001), fewer days of pain (4.8 +/- 1.5 vs. 9.4 +/- 1.2, p <0.001), pain medication withdrawal (2.6 +/- 1.3 vs. 4.5 +/- 1.3, p <0.001) and earlier use of liquid diet (5.1 +/- 1.4 vs. 8.5 +/- 2.1, p <0.001), and fewer school days lost (5.3 +/- 1.7 vs. 8.9 +/- 1.5, p <0.001). After completing this study, plasma tonsillectomy was adopted for the majority of cases. Benefits of the plasma device include the possibility both to excise tissue and coagulate bleeding vessels using the same device whilst improving quality of post-operative recovery over cold dissection with suture ligatures.

Pauci-symptomatic large epidermoid cyst of cerebellopontine angle: case report.

It is estimated that 10% of intra-cranial tumours are localized in the cerebellopontine angle and internal auditory canal and early symptoms of the different histological forms are almost identical. Acoustic neuroma account for 90% and meningioma for 5-10% of these tumours, while a small percentage of rare tumours exist, the most frequent being epidermoid cyst, also known as congenital cholesteatoma or keratoma. The case is reported here of a large epidermoid cyst of the right cerebellopontine angle, and the clinical-radiological course is reviewed. The patient, a 35-year-old, male, initially presented an episode of objective rotatory vertigo, and a history of right ear fullness, of a few months' duration, with normal otoscopy. Audiometric test was normal in left ear, while slight pantonal sensori-neural hypoacusia was observed in the right ear. The impedenzometric findings were normal as was the vestibular test. Auditory brainstem evoked response showed an increased latency of fifth wave. Gadolinium-enhanced magnetic resonance imaging of brain revealed the presence of a voluminous epidermoid cyst occupying the extra-axial side of the right cerebellopontine cistern with superior extension into the cistern. Due to the low-grade of symptoms, we had chosen to wait and not perform surgery immediately, with otologic and vestibular test-controls every 6 months, with cerebral magnetic resonance imaging to control extension of the mass, without radiation exposure for the patient. One year after diagnosis, at the last control, otofunctional findings were not modified and repeat magnetic resonance imaging did not demonstrate important variations compared to the first. Thus, the choice not to proceed with surgery was justified since surgery is burdened by the risk of important complications. At magnetic resonance imaging, the epidermoid cyst, unlike the majority of intra-cranial tumours, such as acoustic neuroma and meningioma, does not show gadolinium-enhancement; this again supporting the important role of magnetic resonance imaging in the differential diagnosis of intra-cranial neoformations. It is, therefore, worthwhile stressing the validity of the approach, step by step, in the diagnosis of patients with otologic symptoms, together with the importance of magnetic resonance imaging that, in comparison with computed tomography, allowed us to exactly assess the growth rate of the mass and to "wait and see" without risks and without radiations for the patient.

Topical versus systemic diclofenac in the treatment of temporo-mandibular joint dysfunction symptoms.

The most frequent symptom of craniomandibular dysfunction is pain in the preauricular area or in the temporo-mandibular joint, usually localized at the level of the masticatory musculature. Patients sometimes also complain of reflect otalgia, headaches and facial pain. Osteoarthrosis is a frequent degenerative debilitating chronic disorder that can affect the temporomandibular joint. It causes pain and articular rigidity, a reduction in mobility, and radiological alterations are visible in stratigraphy. The aim of this study was to compare the efficacy of a topically applied non-steroid anti-inflammatory drug that has recently become commercially available (diclofenac sodium in a patented carrier containing dimethyl sulfoxide, that favours transcutaneous absorption) which is commonly used to alleviate pain in knee or elbow joints, versus oral diclofenac, in the treatment of symptoms of temporomandibular joint dysfunction. Dysfunction of the temporomandibular joint was diagnosed in 36 adult patients. The patients were randomized in two age- and gender -matched groups. Group A (18 patients) received oral diclofenac sodium administered after a meal in 50-mg tablets twice a day for 14 days. Group B (18 patients) received 16 mg/ml topical diclofenac (diclofenac topical solution, 10 drops 4 times a day for 14 days). All patients completed a questionnaire at the start and end of therapy. Patients were asked to quantify on a graded visual analogue scale and to reply to questions about the pain and tenderness of the temporomandibular joint and the functional limitation of mouth opening. Patients were also requested to report side-effects of the treatment. All patients showed relief from pain after treatment: the difference between the two groups was not significant (p > 0.05). Post-treatment, 16 patients of group A had epigastralgic symptoms. Three patients treated with topical diclofenac showed a modest irritation of the temporomandibular joint region, and disappeared spontaneously. Our results demonstrate that topically applied diclofenac and oral diclofenac are equally effective in the treatment of temporomandibular joint dysfunction symptoms. Topical diclofenac has the advantage that it does not have adverse systemic effects, whereas oral diclofenac had untoward effects on the gastric apparatus. The efficacy of diclofenac topically applied on the temporomandibular joint region observed in group B is explained by the association of diclofenac with dimethyl-sulfoxide, which enables a rapid effective penetration into the joint tissues. It is noteworthy that dimethyl-sulfoxide favours transuctaneous absorption when used in a multi-dose regime as in our study with 4 doses a day. Thus, single, "as required", applications should be avoided because this practice results in scarce absorption of diclofenac.

State and trait anxiety in patients affected by nasal polyposis before and after medical treatment.

The present study aimed to establish whether anxiety and depression in nasal polyposis play a role in genesis of the disease, or are a consequence of symptoms. Anxiety levels were evaluated in state and trait forms, and depression, in 30 consecutive patients presenting nasal polyposis before and after effective 7 months' medical treatment with nasal mometasone, loratadine and montelukast. Before and at the end of treatment, patients were asked to fill in the State and Trait Anxiety Inventory and the Zung self-rating depression scale. In 63.15% of patients with high levels of state anxiety before therapy, these were reduced (p < 0.004) after treatment. In 61.9% of patients with high levels of trait anxiety before treatment, these were reduced (p < 0.002) after treatment. There were no significant differences in depression. Anxiety in nasal polyposis is present both as a state and as a trait, and is significantly reduced after effective medical treatment, showing that anxiety is a reversible consequence of nasal polyposis in most cases.

Psychological profile of dysfunctional dysphonia.

A high degree of emotional maladjustment can be detected in dysfunctional dysphonia. In these patients, it is not rare to observe an immediate resolution of the phoniatric disorder, but it is equally as common to identify a significant rate of recurrence (> 10%) in the short and long term. This phenomenon may be due to poor adaptive ability in the presence of mood disorders. Aims of this study were: a. selection of a suitable instrument to identify "minor" and "major" symptoms of psychiatric nature in dysphonic subjects; b. evaluation of profile of mood disorders in dysfunctional dysphonic adults. Hopkins Symptom Check List 90 was chosen. This is a scale of self-evaluation, adapted in Italian, complete (9 dimensions) and easy to use. It is employed to evaluate the following dimensions: somatization, obsessive compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism, sleep disorders. Three groups were studied: group 1:40 patients (36 female, 4 male; aged 18-62 years, mean 42) with dysfunctional dysphonia; group 2: 20 patients (18 female, 2 male; aged 19-61 years, mean 43) with ENT disorders; group 3: 20 subjects (18 female, 2 male; aged 18-62 years, mean 42.2) as controls. In the statistical analysis, a one-way variance between the three groups and a post-hoc analysis using Schiffé test (level of significance 0.05) were carried out. Results showed significant differences between group 1 and groups 2 and 3 as far as concerns anxiety, phobia, obsessive-compulsive, interpersonal sensitivity and somatization variables. A significant difference was found only between groups 1 and 3 as far as concerns the variables: sleep disorders, depression and paranoid ideation. No significant difference emerged between the groups regarding psychoticism and anger/hostility dimensions. The present study identified a definite profile of minor personality disorders, of an anxious nature, with evidence of somatization, interpersonal sensitivity and obsessive-compulsive type traits, significantly prevailing in dysfunctional dysphonic subjects. Symptom Check List-90 has, therefore, proven to be an adequate instrument in the more complete definition of subjects affected by dysfunctional dysphonia aiming at referral to an integrated protocol which focuses on phoniatric treatment using an approach which acts upon the behavioural aspects of communication.

[Virtual laryngoscopy of neoplastic pharyngeal and laryngeal pathology]. / La laringoscopia virtuale nelle neoplastie faringo-laringee.

PURPOSE: This study investigated the feasibility and clinical value of high-resolution virtual laryngoscopy (VL) based on helical CT data sets. MATERIAL AND METHODS: Fifteen patients with neoplastic laryngeal pathology underwent helical CT examination performed with controlled breath. The CT data were downloaded to a workstation equipped with software for three-dimensional rendering (Silicon Graphics O2, Vitrea Visualization 1.2.8). Two radiologists using Fly Through software generated both antegrade and retrograde endoluminal virtual endoscopy navigations of the larynx. The results of the radiological study were compared with conventional endoscopy findings. RESULTS AND CONCLUSIONS: Virtual laryngoscopy provided the correct diagnosis in 13 of 15 cases. VL is capable of simulating the visual findings of endoscopy in cases of laryngeal tumors and subglottic stenosis. Small and plane tumors of the vocal chords are not adequately visualized. This technique appears to be useful both as biopsy guide during conventional laryngoscopy and as a correct pre-surgery staging, particularly in stenotic tumors.

[Mucocele of sphenoid sinus: presentation of 3 cases]. / Il mucocele del seno sfenoidale: presentazione di tre casi clinici.

Sphenoidal mucoceles are equally distributed between males and females occur rarely and have an incidence of 1%. Their low incidence is certainly to be ascribed to their deep position with respect to the superior respiratory tract as well as to the characteristics of the mucosa coating of the sinus (where the scarce muciparous component does not cause drainage problems). During endocranial manifestation, it is important to make a differential diagnosis between tumors at the base of the skull and adenomas of the hypophysis. The most feasible etiopathogenetic hypotheses are insufficient drainage of the sinus, cystic degeneration of the ghiandolar epithelium, presence of embryonal remnants and previous surgery. The Authors report three cases of mucoceles located in the sphenoid, two of which with destruction of the sellar floor and upward invasion, one with posterior invasion and involvement of the clivus. Sphenoidal mucoceles generally tend to spread more frequently in an anterior-inferior fashion with invasion of the etmoid, the nasal fossae and the rhinopharynx. In some cases we observe upward invasion with destruction of the sellar floor, as in the first two patients. There may by an invasion in the orbital cavity when spreading occurs sideways. More rarely, the intermediate cranial fossa is invaded through the lateral wall and the posterior cranial fossa through the posterior wall. Therefore, it is evident that an early diagnosis is always desirable because it may spare the patient the neurological manifestations resulting from the evolution of the disease. The treatment for a sphenoidal mucocele is surgical. The Authors report a synthesis of the surgical techniques most frequently used by otorhinolaryngologist and neurosurgeons, and present a critical analysis of the cases presented.

[Rare manifestation of nasal polyposis in the Peutz-Jeghers syndrome]. / Rare manifestazioni della poliposi nasale nella sindrome di Peutz-Jeghers.

We are relating a case of the Peutz-Jeghers syndrome, a disease characterized by hamartomatous polyposis and by mucocutaneous melanic pigmentation, in a rare variant identified by the presence of nasal polyposis. At the objective E.N.T. examination, the patient's nasal fossae were completely obstructed by translucid masses of a polypoid appearance and, moreover, a melanic pigmentation of the cutis, of the perilabial mucosa and of the oral cavity was encountered. At the X-ray examination and, later, during the operation, also the right maxillary sinus appeared completely obstructed by polypoid masses. At the histologic examination, such polypoid neoformations were quite similar to common polyps of an inflammatory nature and, so, absolutely without any peculiar structural features. The nasal polyposis in patients suffering from the Peutz-Jeghers syndrome has been mentioned by Peutz since his first observation but it has been seldom described in the subsequent publications, even in relation to the presentation of rare causes to Congresses and Magazines of an exclusively gastroenterological interest, in which the main concern was that of identifying both the clinical and histological aspects of gastrointestinal hamartomatous polyposis and the correlation between the syndrome and the formation of malignant neoplasias in other organs to the prejudice of the secondary manifestations of the disease. Nevertheless, the nasal polyposis and, at any rate, the tendency to the formation of polyps in other districts (urinary tract, bronchi) are described among the less important features also in gastroenterological treatises of most recent publication. Clinical observations, even occasional, are completely missing in the E.N.T. ambit.(ABSTRACT TRUNCATED AT 250 WORDS)