Francesco Gazia

Introduction: Bilateral congenital choanal atresia (CCA) is a rare, life-threatening condition in neonates. This is the first reported case of PROPEL steroid-eluting stent use in a seven-day-old bilateral CCA neonate, with a customised technique developed to overcome limitations of the standard applicator. Case Presentation: A full-term male neonate presented with severe respiratory distress and was diagnosed with bilateral CCA. Endoscopic repair with mucoperiosteal flaps and drilling of the atretic plate was performed, followed by placement of a tailored PROPEL stent using a modified insertion with a Nelaton tube system. Outcomes: Recovery was uneventful. At 30 days, the stent remained well-positioned; at two, three, and six months, the neochoana was patent with no restenosis or synechiae. Conclusions: The PROPEL stent, combined with a customised insertion method, may offer a promising alternative for neonatal CCA repair. Further studies are needed to assess long-term outcomes and safety.

Malignant otitis externa (MOE) also known as skull base osteomyelitis or necrotizing otitis externa, is a rare inflammatory and infectious condition mainly caused by Pseudomonas Aeruginosa, mainly affects elderly, diabetic and immunocompromised patients. Due to the rapidity of development, it is associated with a high rate of motility/morbidity. In this case report, we describe a rare neurological presentation in a 58-year-old male patient, diabetic, who presented with onset of right otitis externa associated with otalgia, otorrhea, and ipsilateral headache. The auricular swab was positive for Pseudomonas Aeruginosa, the necrotizing inflammation evolved rapidly with progressive clinical involvement of right cranial nerves VII, V, X (Right recurrent laryngeal nerve), III, IV, VI. The role of imaging was to confirm the initial oto-mastoid involvement and to specify the extent of the lesion. CT-scan assessed bone involvement and the MRI delineated the extent of the inflammatory pathology. During the first months of his recovery, the patient contracted SARSCOV- 2 infection, which induced a clinical and radiological worsening of the initial pattern in relation to the hypoxemic states achieved in the course of interstitial pneumonia. Finally the patient was treated with Meropenem 1 g ev per day. At the end of treatment, the patient presents almost complete resolution of pathology on both clinical and radiological bases. The aim of this manuscript is to report the management and treatment of a rare case of MOE co-infected with SARS-COV-2.

Objectives: The aim of this study is to analyze the correlation between the nasal anatomical variants and the clinical and radiological features of odontogenic sinusitis to demonstrate their possible involvement in the genesis of the disease. Methods: This is a retrospective multicentric study of 70 patients with odontogenic sinusitis (OS). Before surgery, all patients performed the classic and mini 22-item Sino-Nasal Outcome Test (SNOT-22 and SNOT-8) and Lund–Mackay Score (LMS). Each nasal anatomical anomaly was collected, including paradoxical middle turbinate (PMT), chonca bullosa (CB), and nasal septal deviation (NSD) on the same side as the sinusitis. Results: The patients presented a significantly higher SNOT-22 and SNOT-8 score only in case of association with NSD and PMT/CB. Logistic regression showed that the variables were significantly associated (p = 0.02 and 0.04). No significant correlation was found between LMS and anatomical variations. Conclusions: This study showed that nasal anatomical variables are correlated with SNOT-22 and SNOT-8. Having a combination of NSD and CB or PMT, on the same side as an OS, is related to a worse quality of life in patients affected by this disease. Regarding the radiological features of OS, no significant correlation was found between LMS and anatomical variations.

Purpose The aim of this study is to analyse the possible spontaneous regression of severe adenoid hypertrophy in patients who performed nasal surgery. Methods Following the inclusion criteria, 83 adult patients were retrospective selected. These patients were characterized by adenoid hypertrophy from second to fourth grade before performing septoplasty andbilateral or monolateral reduction of hypertrophy of the turbinates and/or endoscopical sinus surgery (ESS). Results Adenoid hypertrophy (grade 2-3-4) can be noted in 6.8% (83/1220) of patients who performed nasal surgery. Regarding the grade of hypertrophy before and after surgery, a clear decrease in adenoid size was obtained after nasal surgery (p < 0.001), without performing adenoidectomy, after at least one year of follow-up. Conclusion Spontaneous regression of severe adenoid hypertrophy was observed in all patients who performed nasal surgery. Avoid adenoidectomy during nasal surgery should be a great advantage for patients, eliminating the possibility of complications such as bleeding and uncontrolled scars.

Background/Objectives: Given the importance of emotion recognition for communication purposes, and the impairment for such skill in CI users despite impressive language performances, the aim of the present study was to investigate the neural correlates of emotion recognition skills, apart from language, in adult unilateral CI (UCI) users during a music in noise (happy/sad) recognition task. Furthermore, asymmetry was investigated through electroencephalographic (EEG) rhythm, given the traditional concept of hemispheric lateralization for emotional processing, and the intrinsic asymmetry due to the clinical UCI condition. Methods: Twenty adult UCI users and eight normal hearing (NH) controls were recruited. EEG gamma and alpha band power was assessed as there is evidence of a relationship between gamma and emotional response and between alpha asymmetry and tendency to approach or withdraw from stimuli. The TAS-20 questionnaire (alexithymia) was completed by the participants. Results: The results showed no effect of background noise, while supporting that gamma activity related to emotion processing shows alterations in the UCI group compared to the NH group, and that these alterations are also modulated by the etiology of deafness. In particular, relative higher gamma activity in the CI side corresponds to positive processes, correlated with higher emotion recognition abilities, whereas gamma activity in the non-CI side may be related to positive processes inversely correlated with alexithymia and also inversely correlated with age; a correlation between TAS-20 scores and age was found only in the NH group. Conclusions: EEG gamma activity appears to be fundamental to the processing of the emotional aspect of music and also to the psychocognitive emotion-related component in adults with CI.

Cochlear implants (CI) allow deaf patients to improve language perception and improving their emotional valence assessment. Electroencephalographic (EEG) measures were employed so far to improve CI programming reliability and to evaluate listening effort in auditory tasks, which are particularly useful in conditions when subjective evaluations are scarcely appliable or reliable. Unfortunately, the presence of CI on the scalp introduces an electrical artifact coupled to EEG signals that masks physiological features recorded by electrodes close to the site of implant. Currently, methods for CI artifact removal have been developed for very specific EEG montages or protocols, while others require many scalp electrodes. In this study, we propose a method based on the Multi-channel Wiener filter (MWF) to overcome those shortcomings. Nine children with unilateral CI and nine age-matched normal hearing children (control) participated in the study. EEG data were acquired on a relatively low number of electrodes (n = 16) during resting condition and during an auditory task. The obtained results obtained allowed to characterize CI artifact on the affected electrode and to significantly reduce, if not remove it through MWF filtering. Moreover, the results indicate, by comparing the two sample populations, that the EEG data loss is minimal in CI users after filtering, and that data maintain EEG physiological characteristics.

Rhinogenic headache (RH), arising from nasal and sinus pathologies, present a diagnostic challenge due to their diverse etiologies. This study investigates a unique case where RH coincides with infraorbital nerve dehiscence, delving into the intricate relationship between sinonasal anatomy and neurovascular complications. The infraorbital nerve contacted a cyst in the maxillary sinus. Centripetal endoscopic sinus surgery was performed to open the maxillary sinus and remove the cyst. After 3 months of follow-up, the patient had a notable improvement in symptoms with a reduced headache. This case highlights the significance of considering uncommon anatomic variations, such as infraorbital nerve dehiscence, within the context of RH. Diligent history-taking and appropriate use of radiologic investigations are pivotal for guiding clinicians toward an accurate diagnosis and determining the most appropriate course of treatment.

Background: This study aimed to evaluate the safety and efficacy of povidone-iodine 0.6% (PVI) irrigation for preventing recurrence of stenosis after punctoplasty in patients with punctal and proximal canalicular stenosis treated using a venous catheter as a stent. Methods: Twenty patients were enrolled and divided into two groups. Group 1 received irrigation of 1 mL 0.6% PVI, while Group 2 received 1 mL of balanced salt solution (BSS). The patients underwent baseline, 15-, 30-, and 90-day assessments using the Ocular Surface Disease Index (OSDI) questionnaire, Symptoms Assessment in Dry Eye (SANDE), Schirmer I test, tear meniscus height (TMH), bulbar redness, meibography, and non-invasive breakup time (NIKBUT) through Keratograph 5M (Oculus, Germany). Results: At three months, both groups demonstrated statistically significant improvements in symptoms and ocular surface parameters. However, Group 1 showed statistically significant improvements in OSDI, SANDE scores, bulbar redness, and NIKBUT compared to Group 2. Additionally, no patients in Group 1 presented a recurrence of stenosis, while three patients in Group 2 demonstrated stenosis relapse at the end of the follow-up period. Conclusions: The application of a venous catheter and PVI 0.6% irrigations proved to be effective in treating proximal lacrimal duct stenosis, reducing the risk of recurrence and improving tear film stability, ocular discomfort symptoms, and ocular surface parameters.