Acute mastoiditis (AM) is a common complication of acute otitis media in children. There is currently no consensus on criteria for diagnosis. Head CT is the most frequent diagnostic tool used in the ED although the increasing awareness on the use of ionized radiations in children has questioned the use of CT imaging versus solely using clinical criteria. Our research aimed to understand if CT imaging was essential in making a diagnosis of AM. We retrospectively analyzed medical records from pediatric patients who accessed our Pediatric Emergency Department (ED) between January 2014 and December 2020, with a clinical suspicion of AM. We reviewed clinical symptoms upon presentation, head CT and lab values (white blood cell count or WBC, C-Reactive Protein or CRP) when done, presence of complications and discharge diagnosis. A multilogistic regression model was specified to establish the role of clinical features and of CT in the diagnosis of AM based on 77 patients. Otalgia (OR= 5.01; 95% CI= 1.52-16.51), protrusion of the auricle (OR= 8.42; 95% CI= 1.37-51.64) and hyperemia (OR= 4.07; 95% CI= 1.09-15.23) of the mastoid were the symptoms strongly associated with a higher probability of AM. In addition to clinical features, the adjusted OR conferred by head CT was 3.09 (95% CI = 0.92-10.34). Clinical signs were most likely predictive of AM in our sample when compared to Head CT. Most common symptoms were protrusion of the auricle, hyperemia or swelling behind the ear and otalgia. (www.actabiomedica.it)

Background/Objectives: Sudden sensorineural hearing loss (SSNHL) represents a challenging clinical entity with variable prognosis. Audiometric curve configuration has been proposed as a predictor of recovery. This study aimed to evaluate the association between audiogram morphology at onset and hearing outcome in patients with idiopathic unilateral SSNHL treated with standardized therapy. Methods: We retrospectively analyzed 156 patients with idiopathic SSNHL. Hearing thresholds at key frequencies were measured at baseline and 4 weeks post-treatment. Patients were categorized into upsloping, flat, downsloping, or U-shaped audiogram subgroups. Recovery was classified into four levels. Comparisons were made across subgroups for audiometric and laboratory data using ANOVA and chi-square tests. Results: Baseline PTA values were comparable across audiogram subgroups (p = 0.12). Hearing recovery differed significantly according to audiogram configuration (chi-square, p < 0.001), with upsloping and U-shaped patterns showing the best outcomes. Flat and downsloping curves were associated with poorer recovery, lower HDL, and elevated NLR values. Conclusions: Audiogram configuration is a relevant prognostic marker in SSNHL. Patterns linked to adverse metabolic and inflammatory profiles may benefit from tailored treatment strategies in a personalized medicine framework.

To analyze the voice-related issues in laryngectomized patients with voice prosthesis (VP) and to evaluate the effectiveness of voice therapy (VT) in their management. The retrospective analysis included 194 patients (170 M, 24 F; mean age 64.86 ± 10.09 years) who underwent total laryngectomy (TL) with VP placement and subsequent VT between May 2010 and May 2024. In this study, patients were categorized based on vocal symptoms and underlying causes. To investigate issue resolution solving and outcomes, post-TV outcomes were analyzed using patient-reported outcome measures (PROMs) and auditory-perceptual assessments. Specifically, the Italian Self-Evaluation of Communication Experiences After Laryngeal Cancer (I-SECEL) and University of Washington Quality of Life (UWQoL-v4) Questionnaires, and the INFVo scale. 100 out of 194 patients (51.55%) presented a voice-related issue (82 M, 18 F; mean age 67 ± 9.35 years). The age over 65 years and female sex increased the incidence of voice-related complications. Hypertonic voice was the most frequent issue (40%) and was resolved in 72% of cases through ∼20 sessions of VT. This resolution rate increased to 95% when combined with botulinum toxin injections. No results were recorded in cases of hypertonic voice associated with post-radiation fibrosis. Problems related to the stoma, anatomical abnormalities, interference between esophageal and tracheoesophageal (TE) voice, and radiotherapy, as well as hypotonic and poor-quality voices, achieved a 100% resolution rate after 5-15 sessions of VT. Issues related to breathing, coordination and posture achieved a resolution rate of 92%, with lower-quality vocal outcomes. The implementation of specific VT allowed for an overall resolution of 92% of treated cases, reaching a success rate of 95% in the entire cohort of patients (N = 194). In the treatment of TE voice, identifying voice-related issues through patient assessment and symptoms analysis allows for targeted VT, leading to higher success rate.

Epistaxis, particularly in Hereditary Hemorrhagic Telangiectasia (HHT) patients, is a common otolaryngological emergency, often requiring complex management. A hierarchy of increasingly invasive interventions, from external compression of the nasal pyramid to nostril closure, is typically proposed and applied. We conducted a retrospective study on HHT patients to assess the effectiveness and longevity of invasive procedures postoperatively. Data were collected using the Epistaxis Severity Score (ESS) questionnaire. The primary focus was on changes in the frequency and intensity of epistaxis, while the secondary focus was on the overall quality of life. The study found that invasive procedures initially improved the frequency and intensity of epistaxis in HHT patients. However, within one to 9 months postoperatively, these benefits often diminished, with hemorrhagic symptoms recurring at similar or worsened levels. Facial trauma further negated the advantages of these procedures. The findings suggest a need for a gradual and increasingly invasive approach to managing epistaxis in HHT patients. Highly invasive procedures should be reserved for cases where less invasive methods fail, due to their limited temporal effectiveness and the risk of causing anatomical-functional changes in the rhino-sinus area, complicating future management of severe epistaxis.

Objective: Oral squamous cell carcinoma (OSCC) is a prevalent form of head and neck squamous cell carcinoma (HNSCC). Traditional treatments include surgery and radiotherapy/chemotherapy, but these often have limited efficacy. Immunotherapy has emerged as a promising treatment option. Recognition of novel biomarkers for immune checkpoints modulation could be helpful for establishing a personalized treatment for OSCC patients. Recently we showed that HNSCC epithelial cells acquire the ability to express class II MHC, HLA-DR. We aimed to investigate HLA-DR role in relation to the presence of the tumor microenvironment represented by CAFs. In addition, since programmed death-ligand 1 protein (PD-L1) is a critical target for cancer immunotherapy in HNSCC, we evaluated HLA-DR and PD-L1 level in healthy and OSCC tissues. Methods: Biopsy specimens from five OSCC patients were used to isolate tumor cells, normal fibroblast and CAFs. HLA-DR expression was evaluated. Cancer Genome Atlas database was used to evaluate HLA-DR and PD-L1 level in normal tissues and HNSCC derived biopsies. Results: Epithelial cancer cells showed de-novo HLA-DR expression. Importantly, HLA-DR expression was observed in both CAFs and normal fibroblasts with a significant higher level in CAFs. Atlas analysis showed an increase of HLA-DR and PD-L1 expression in HNSCC derived biopsies vs normal tissues and a positive correlation between HLA-DR and PD-L1 in cancer samples. Conclusions: Our findings highlighted that tumoral environment could affect OSCC cells inducing HLA-DR expression in non-APC tumoral and CAFs cells. The correlation between PD-L1 and HLA-DR expression has been observed, providing useful insights in targeted immunotherapy strategies for OSCC management.