Background. Previous studies reported human papillomaviruses (HPVs) in middle ear tumors, whereas these viruses have been poorly investigated in chronic inflammatory middle ear diseases. We investigated HPVs in non-tumor middle ear diseases, including chronic otitis media (COM). Methods. COM specimens (n = 52), including chronic suppurative otitis media (CSOM) (n =38) and cholesteatoma (COMC) (n = 14), as well as normal middle ear (NME) specimens (n = 56) were analyzed. HPV sequences and DNA loads were analyzed by quantitative-PCR. HPV genotyping was performed by direct sequencing. Results. HPV DNA was detected in 23% (12/52) of COM and in 30.4% (17/56) of NME (p > 0.05). Specifically, HPV DNA sequences were found in 26.3% (10/38) of CSOM and in 14.3% (2/14) of COMC (p > 0.05). Interestingly, the HPV DNA load was higher in COMC (mean 7.47 copy/cell) than in CSOM (mean 1.02 copy/cell) and NME (mean 1.18 copy/cell) (P = 0.03 and P = 0.017 versus CSOM and NME, respectively). HPV16 and HPV18 were the main genotypes detected in COMC, CSOM and NME. Conclusions. These data suggest that HPV may infect the middle ear mucosa, whereas HPV-positive COMCs are associated with higher viral DNA loads as compared to NME.

Background The purpose of this study was to evaluate the prevalence of position-dependent obstructive sleep apnea (POSA) in elderly patients (≥65 years old). Adult (range 19-65 years old) and elderly patients were also compared in order to show differences in the incidence of POSA between these two groups of patients. Methods A prospective bi-center study was performed between January 2018 and May 2019. A total of 434 participants underwent polysomnography (PSG) study at home (Embletta MPR). Body position during the PSG recordings was determined. Patients were subdivided in two groups: those aged between 19 and 65 years old (adult patients) and ≥65 years old (elderly patients). POSA patients were defined using Cartwright’s system, Bignold classification, and the new Amsterdam Positional OSA Classification (APOC). Results The prevalence of POSA in elderly patients differed according to the classification system used: 49.3% using Cartwright’s classification system, 20.5% with the Bignold classification, and 22.6%, 38.9%, and 5.4% of APOC 1, APOC 2, and APOC3 sub-classes were respectively identified for the APOC classification system. No difference between adult and elderly patients regarding the prevalence of POSA was observed. No statistical differences emerged between the two groups of patients in terms of supine (p = 0.9) and non-supine AHI (p = 0.4). Conclusions A significant number of elderly patients could be considered treatable with positional therapy according to the APOC classification. However, the efficacy and applicability of positional therapy in elderly patients must be confirmed by further research.

Background. To evaluate the possible effects of Rapid Maxillary Expansion (RME), such as nasal breathing problems, middle ear function, Obstructive Sleep Apnea (OSA) in the otolaryngology field. RME has already been introduced in orthodontics to expand the maxilla of young patients affected by transversal maxillary constriction. Methods. A literature search was performed using different databases (Medline/PubMed, EMBASE, and CINAHL), from May 2005 to November 2021, according to the PRISMA guidelines. Results. The application of RME in children has shown good results on nasal function, reducing nasal resistances, independently from a previous adenotonsillectomy. These results are not only related to the increasing of nasal transverse diameters and volume, but also to the stiffening of airway muscles, enabling the nasal filtrum function and avoiding mouth opening, thereby decreasing respiratory infections. Positive effects have also been reported for the treatment of conductive hearing loss and of OSA, with the reduction of Apnea Hypopnea Index (AHI), possibly due to (i) an increased pharyngeal dimensions, (ii) a new tongue posture, and (iii) reduced nasal respiratory problems. Conclusions. Otolaryngologists should be aware of the indications and benefits of the RME treatment, considering its possible multiple beneficial effects.

Obstructive sleep apnea syndrome (OSAS) is a sleep breathing disorder characterized by periods of cessation (apnea) and/or reduction (hypopnea) of oronasal airflow during sleep accompanied by drops in the blood oxygen level caused by repetitive upper airway obstructions.¹ Identifying the site of obstruction and the pattern of airway collapse during sleep are essential key points to guide nonventilatory treatment decision making processes for OSAS in adults. Several studies have shown that upper airway endoscopic findings from tests performed while the patient is awake do not correspond exactly to obstructive sleep events.^2,3 First introduced by Croft and Pringle⁴ in 1991, drug-induced sleep endoscopy (DISE) is a diagnostic technique providing a dynamic anatomical analysis of the upper airways during the pharmacologic induction of artificial sleep. Direct observation of anatomical modifications, such as collapse, vibrations, apnea or hypopnea, and their localization, is provided by a flexible fiber optic nasopharyngoscope. The lack of standardization in the DISE technique, including sedation, operation procedure, and classification, has produced several variations in the performance of DISE.⁵ In particular, the detection of obstructive events depends on the direct visual observation of changes in upper airway caliber, causing a subjective interpretation of the test results and, consequently, poor intraobserver and interobserver reliability when otolaryngology surgeons not experienced in the technique are involved.⁶

Purpose: Evaluate the effectiveness of the head-of-bed elevation position (HOBE) with a 30° elevation of the head and trunk, in improving obstruction of the upper airways in obstructive sleep apnea (OSA) patients. A prospective trial simultaneously performing drug-induced sleep endoscopy (DISE) and polysomnography (PSG) tests was performed. Methods: Forty-five patients were included in the prospective study protocol. All patients enrolled in the study and underwent the following evaluations: (1) a drug-induced sleep endoscopy, with an evaluation of obstructions and collapse of the upper airways at 0° and in a HOBE position, with head and trunk elevation of 30°; (2) an overnight PSG assessment in the hospital with head and trunk elevation from 0° to 30° during the night; (3) a questionnaire to evaluate the feedback of patients to sleeping with head-of-bed elevation. Results: Velum (V) and oropharynx lateral wall (O) collapses were reduced in the 30° up position. There were no statistical differences that emerged in the obstruction of the tongue base and epiglottis between the 0° position and the 30° up position (p > 0.05). The average AHI score changed from 23.8 ± 13.3 (0° supine position) to 17.7 ± 12.4 (HOBE position), with a statistical difference (p = 0.03); the same statistical difference emerged in the percentage of apneas that decreased from 55 ± 28.1 to 44 ± 25.8 (p = 0.05). Conclusions: By adopting the HOBE position with 30° elevation of the head and trunk, it is possible to obtain a reduction of upper airways collapses and an improvement of apnea/hypopnea events and nightly respiratory outcomes.