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PURPOSE: No study to date has described the overall landscape of sleep disorders management and training in otolaryngology departments of different countries. The aim of our study was to investigate and compare settings, diagnostic and therapeutic approaches and training programmes. METHODS: An international online survey was developed with the collaboration of the YO-IFOS (Young Otolaryngologists-International Federation of Otorhinolaryngological Societies) to assess the current practice of otolaryngologists in the management of sleep disorders. The survey also included a session dedicated to training. RESULTS: A total of 126 otolaryngologists completed the survey. The larger part of responses was collected from Central/South America and Europe. The majority of responders from South/Central America (97%) declared to be certified as sleep specialist while 49% of Europeans stated the opposite. Of responders 83% perform a drug-induced sleep endoscopy (DISE) before planning a possible surgical intervention. Soft palate and base of tongue interventions were the most common procedure, respectively performed in 94% and 79% of the cases. Residents were allowed to perform soft palate surgery in 77% of the cases. Upper airway stimulation (26% vs 10%), trans-oral robotic surgery (36% vs 11%) and radiofrequency of the base of the tongue (58% vs 25%) were preferred more frequently by European responders. The highest caseloads of soft palate surgery and bi-maxillary advancement were registered in the academic institutions. CONCLUSION: Significant concordance and few interesting divergences in diagnosis and treatment of sleep disorders were observed between nationalities and types of institution. Economic resources might have played a significant role in the therapeutic choice. Trainees' lack of exposure to certain interventions and to a sufficient caseload appeared to be the main burden to overcome.

International audience; To review the data regarding the expression of angiotensin converting enzyme-2 (ACE2) and transmembrane protease serine-2 (TMPRSS2) in head and neck tissue. Scopus, Cochrane Library, Medrxiv, Google Scholar and PubMED/MEDLINE were searched by four independent investigators for studies investigating ACE2 or TMPRSS2 expressions in head and neck tissues. The following outcomes were considered: sample origin (animal versus human); detection method; anatomical location and cell types. PRISMA checklist and modified population, intervention, comparison, outcome, timing and setting (PICOTS) framework were used to perform the review. Of the 24 identified studies, 17 met our inclusion criteria. Thirteen studies were conducted during the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic. ACE2 and TMPRSS2 were expressed in oral, pharyngeal, sinusonasal human mucosa. The following cell types expressed ACE2: basal, apical, goblet, minor salivary, and endothelial cells. TMPRSS2 was found in goblet and apical respiratory cells. ACE2 and TMPRSS2 were found in the olfactory region, especially in sustentacular non-neural and neural stem cells. Animal studies suggested that ACE2 expression may vary regarding age. There was an important heterogeneity between studies in the methods used to detect ACE2 and TMPRSS2, leading to a potential identification bias. The SARS-CoV-2 receptors, ACE2 and TMPRSS2, are both expressed in many head and neck tissues, enabling the viral entry into the host organism.

Objectives: To evaluate the correlation between voice disorders and psychological distress, in terms of anxiety, stress, and depression, in a sample of adult Italian patients and to compare our results with those obtained in a group of adult healthy controls matched by age, sex, geographic distribution, and occupation. Methods: This prospective-controlled study included 100 adults with Vocal nodules (VN) and Muscle Tension Dysphonia (MTD1), aged between 18 and 65 years, as Experimental Group (EG) and 100 age-matched subjects without any voice disorders as a Control Group (CG). All patients in the EG underwent a phoniatric evaluation, including the administration of the Voice Handicap Index (VHI) and laryngeal examination. Both patients of EG and CG underwent a Psychological evaluation by means of standardized tests; Beck's Depression Inventory, State Anxiety Inventory (STAI 1-State Anxiety), Trait Anxiety Inventory (STAI 2- Trait Anxiety), and Perceived Stress Scale (PSS-10) were completed by patients. Fisher's exact test and chi-squared test were used to compare all categorical variables, whereas numerical variables were compared either with the nonparametric Mann-Whitney-Wilcoxon or with Kruskal Wallis test. General linear models were used to study continuous variables between patients and controls and between different groups within the sample. Results: In the study group, the Physical domain (P score) of the VHI was more affected than the Emotional (E score) and Functional ones (F score) both in patients with MTD1 and VN; patients with VN presented a significant difference in P score, E score and VHI total score than patients with isolated MTD 1 (P < 0.005). Psychological assessment showed a significant difference (P < 0.005) between VN and MTD 1 regarding PSS-10 and STAI-1 scores. Low Beck's Depression Inventory scores were present in our sample without significant differences between patients with VN and those with MTD 1. Scores related to psychological distress in the EG were far superior to those obtained by the healthy CG, with markedly significant values especially for PSS-10 (P < 0.0001) and STAI 2 (P < 0.01). Finally, younger patients (18-35 years) with VN showed a highest risk of psychosocial distress. Conclusion: the present study identified a high prevalence of psychological distress among patients with vocal disorders without any prior specific psychiatric diagnosis, especially in terms of anxiety and perceived stress. For this reason both these symptoms should be taken into consideration in the diagnostic, therapeutic, and follow-up process of patients with MTD1 and VN.

Objectives: To confirm the data reported in our previous studies on the analysis of the variability of the electroglottographic signal in the pathological voice; to evaluate possible differences in variability between organic and functional pathologies; to identify any distinctive/typical EGG patterns for these pathologies. Methods: One hundred twenty-five subjects were enrolled (36 euphonic and 89 pathological: 24 functional dysphonia, 21 bilateral vocal nodules, 23 unilateral polyps and 21 unilateral cysts). All subjects were studied with videolaryngostroboscopy, spectrographic analysis of voice and electroglottography (EGG). The EGG signal variability was then investigated using amplitude-speed combined analysis, by means of a proprietary software algorithm. Amplitude and Speed variation were expressed as a new parameter, the Variability Index (VI), calculated both for the whole EGG signal recorded (VI-tot) and in each phase of the glottic cycle (VI-Q, absolute value; VI-Q%, percentage value). Results: In the comparison of VI values between pathological and normal groups, VI-tot and VI-Q2% (which corresponds to the final phase of vocal fold contact) were significantly greater in pathological subjects (P= 0.002). The comparison of VI values among subgroups of the various pathologies showed a difference for VI-tot (P< 0.0001) and VI-Q2% (P= 0.001); this difference was more marked in the cysts than in the functional dysphonia. The cut-off values of VI-tot and VI-Q2% were 0.191 and 18.17%, respectively (sensitivity and specificity 65.2% and 66.7% for VI-tot and 84.3% and 77.8% for VI-Q2%). Conclusions: The variability of the EGG signal investigated through the combined analysis of the amplitude and the speed of vibration using a proprietary algorithm software has proved useful not only to distinguish the normal voice from the pathological voice, but also to characterize which phases are more altered in the various voice pathologies studied, both functional and organic. Furthermore, the analysis of the VI parameter allowed to propose cut-off values characterized by a good sensitivity and specificity to discriminate dysphonia from the euphonic voice. Larger groups of patients will be needed to confirm these results.

Objectives To investigate the role of gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) in the development of dental disorders. Methods The first outcome was review of the role of reflux in the development of dental disorders in adults. The second outcome was review of the potential pathophysiological mechanisms underlying the association between reflux and dental disorders. Three investigators screened publications for eligibility and exclusion based on predetermined criteria through a literature search conducted on PubMed, Cochrane Library, and Scopus according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results From 386 publications, 24 studies were kept for analysis. Objective approaches were used in 16 studies to confirm GERD diagnosis. Pharyngeal reflux episodes (LPR) were considered in 2 studies. No study considered nonacid reflux. The study results supported a higher prevalence of dental erosion and caries in reflux patients compared with healthy individuals. Patients with dental erosion have a higher prevalence of reflux than controls. The pathophysiological mechanisms would involve changes in the saliva physiology. No study investigated the microbiota modifications related to reflux although the findings are supporting the critical role of microbiota change in the development of dental disorders. There is an important heterogeneity between studies about diagnostic methods and clinical outcome evaluation. Conclusion The involvement of reflux in the development of dental disorders is not formally demonstrated and requires future investigations considering pharyngeal acid and nonacid reflux episodes and in particular their potential impact on oral microbiota., SCOPUS: re.j, info:eu-repo/semantics/published

Objective: To investigate the coronavirus disease 2019 (COVID-19) status of patients with initial sudden olfactory anosmia (ISOA) through nasopharyngeal swabs for reverse transcription–polymerase chain reaction (RT-PCR) analysis and to explore their olfactory dysfunctions with psychophysical olfactory evaluation. Methods: A total of 78 ISOA patients were recruited from April 6, 2020, to April 10, 2020, through a public call of University of Mons (Mons, Belgium). Patients benefited from nasopharyngeal swabs and fulfilled the patient-reported outcome questionnaire. Among them, 46 patients performed psychophysical olfactory evaluation using olfactory identification testing. Based on the duration of the ISOA, 2 groups of patients were compared: patients with olfactory dysfunction duration ≤12 days (group 1) and those with duration >12 days (group 2). Results: In group 1, 42 patients (87.5%) had a positive viral load determined by RT-PCR and 6 patients (12.5%) were negative. In group 2, 7 patients (23%) had a positive viral load and 23 patients (77%) were negative. The psychophysical olfactory evaluation reported that anosmia and hyposmia occurred in 24 (52%) and 11 (24%) patients, respectively. Eleven patients were normosmic. The viral load was significantly higher in patients of group 1 compared with those of group 2. Conclusions: Coronavirus disease 2019 was detected in a high proportion of ISOA patients, especially over the first 12 days of olfactory dysfunction. Anosmia is an important symptom to consider in the detection of COVID-19 infection.

Voice disorders are a significant public health issue; their lifetime prevalence is as high as 30% in the general population but much higher in professional voice users.1,2 Severe dysphonia is a very fatiguing condition with a negative impact on the social and professional life. In the era of the coronavirus disease 2019 (COVID-19) pandemic, lock-down and social restrictions have caused an abrupt interruption of voice therapy programs. This lack of care may impact the possibility of reestablishing a socially acceptable voice in a reasonable time, having a possible negative impact on professional careers and emotional life. At the time of writing this paper, in Western Europe, we are facing a progressive reduction in the number of people infected by the novel coronavirus. Nevertheless, the projection of the virus circulation in the post-pandemic period is predicting the possibility of several future clusters.3 Therefore we cannot imagine that the most vulnerable patients would still be regularly coming into a busy office to undergo voice therapy sessions. Currently, telemedicine has made incredible progress in a matter of a few weeks and can be valuable not only for the health of patients, but also to help them build and strengthen their resilience in such a difficult time of isolation and loneliness. Previous studies found that telemedicine may be useful in voice therapy.4 Telemedicine can be practiced on several platforms easily accessed with an electronic device. Currently, in Italy and France, we are facing several impediments regarding the wide use of remote voice therapy. We identified four main obstacles. First, in most hospitals the basic equipment is still unavailable. Many departments have no high-quality camera or software allowing the use of Telemedicine. Second, some voice therapists do not feel confident with the new technologies. Third, elderly individuals or patients who have a low income may not have easy access to electronic devices. However, in Western Europe, most patients own at least a smartphone. Four, the social health system and private insurance companies in many European countries do not recognize remote voice therapy sessions as reimbursable procedures. This is the main barrier that explains why the procedure is still underused. Due to the COVID-19 outbreak, speech therapists should be aware that most voice rehabilitative exercises are aerosol-generating procedures, such as breathing exercises and the widely used “semi-occluded voice therapy exercises” (SOVTEs).5,6 They are based on narrowing of the cross-sectional area of the vocal tract obtained to improve voice resonance by enhancing the interaction between the vocal folds and the vocal tract.5 SOVTEs can generate an aerosol generated by the turbulent flow occurring at the site of vocal tract narrowing. The most popular SOVTEs include lip and tongue trills and phonation into a straw or a tube into the air or water.7 Spreading in the room of contaminated droplets may cause the risk of viral aerosol inhalation for both the voice therapist and for the patient when the therapist is demonstrating it. The voice therapist should use personal protective equipment, such as facemasks and shields, considering that any patient might be an asymptomatic carrier of the novel coronavirus. However, the availability of protective equipment is limited in Europe, which may hinder access to a regular daily supply for the voice therapist. Another important question is: “could a voice therapy session be effective if the therapist is wearing a mask?” The sound of him/her voice would be muffled and distorted, articulatory movements would be not visible, and the speech therapist could not demonstrate exercises such as phonating into a tube or a straw or doing lip or tongue trills. Moreover, the patient might be unable to perform vocal exercises if wearing any type of facemask, and the therapist might have trouble assuring that the exercises were being done correctly. A different way to perform voice therapy is highly desirable in the context of the COVID-19 pandemic, and its development may also be valuable for potential future pandemics as well as for future routine care. Telemedicine offers the opportunity for this change and may allow patients to receive care in their home, without exposure to risk of infection. The voice therapist may demonstrate the exercises being seen and heard on a screen and, at the same time, may check how the patient is performing the exercises. Virtual voice therapy offers a great opportunity for all patients to have easy access to rehabilitation and can be valuable for those affected by mobility impairment or living a long distance away from the facility. Furthermore, the ability to invite a guest or observer to the encounter is another valuable opportunity to offer further support to the patient, considering that, currently, the patient cannot be accompanied in the medical unit by anyone due to the risk of contamination and the distancing measures required by the governments. The COVID-19 pandemic may change some speech therapy practices for the better, and it is time to overcome resistance to new technologies. For this reason, both private insurance companies and public healthcare systems have to work to recognize the opportunities related to “telespeech therapy,” ensuring efficient and effective healthcare continuity.

Based on observations described in our letter, we can draw the following conclusions: (1) anosmia must imperatively be added to the list of specific symptoms of COVID-19 infection, (2) anosmia can serve as a free and specific diagnostic tool for developing countries currently affected by the pandemic, (3) the mechanisms of COVID-19 anosmia seem not to directly involve nasal obstruction but rather seem to be related to damage the olfactory neuroepithelium.

Objectives Evaluation of the reliability and the validity of the Italian version of the Bus Story Test (I-BST), providing normative data in Italian children. Methods A total of 552 normally developing children (278 males and 274 females) aged 3; 6 to 9; 0 years, were enrolled. Test-retest, intra- and inter-rater reliability were analysed on a sample of respectively 145, 178 and 178 children. Normative data were gathered from all the enrolled children and estimate centiles according to the CG-LMS method provided. The children were divided into 11 age classes of six months each; percentile scores and standard error measurement were analysed in children from age class 4; 0-4; 5 years to age class 8; 6-811 years. Age effects on I-BST were analysed. Results Results showed high test-retest, intra- and inter-rater reliability scores. A significant age effect on I-BST scores emerged from the ANOVA test analysis; in particular, as age increases, so do I-BST scores. Conclusion The I-BST is a reliable and valid tool. The availability of normative data for Italian speaking children may help clinicians during clinical assessment.

We present a web geo-spatial framework for analyzing and continuously monitoring the spatio-temporal evolution of disease hot spots for detecting spatial areas with high concentrations of events in a geographic information system (GIS). To detect the hot spots, we adopt Extended Fuzzy C-Means algorithm. Each event is given by the geo-positional coordinates of the place of residence of the patient. The analyst can insert event data directly on the map or digitizing the address of the residence of the patient and using geo-coding services for locating the event. In our experiments, the data consist of geo-referenced patterns corresponding to the residence of patients in the district of Naples (Italy) submitted to a surgical intervention concerning the oto-laryngo-pharyngeal apparatus between the years 2008 and 2012. The results show the presence of two greatest hot spots: the first covers a geographical area that affects the city of Naples, the second covers parts of various towns around the famous vulcan Vesuvius, respectively. We present a web geo-spatial framework for analyzing and continuously monitoring the spatio-temporal evolution of disease hot spots for detecting spatial areas with high concentrations of events in a geographic information system (GIS). To detect the hot spots, we adopt Extended Fuzzy C-Means algorithm. Each event is given by the geo-positional coordinates of the place of residence of the patient. The analyst can insert event data directly on the map or digitizing the address of the residence of the patient and using geo-coding services for locating the event. In our experiments, the data consist of geo-referenced patterns corresponding to the residence of patients in the district of Naples (Italy) submitted to a surgical intervention concerning the oto-laryngo-pharyngeal apparatus between the years 2008 and 2012. The results show the presence of two greatest hot spots: the first covers a geographical area that affects the city of Naples, the second covers parts of various towns around the famous vulcan Vesuvius, respectively.

Modulation of extracellular matrix (ECM) remodeling after peripheral nerve injury (PNI) could represent a valid therapeutic strategy to prevent maladaptive synaptic plasticity in central nervous system (CNS). Inhibition of matrix metalloproteinases (MMPs) and maintaining a neurotrophic support could represent two approaches to prevent or reduce the maladaptive plastic changes in the ventral horn of spinal cord following PNI. The purpose of our study was to analyze changes in the ventral horn produced by gliopathy determined by the suffering of motor neurons following spared nerve injury (SNI) of the sciatic nerve and how the intrathecal (i.t.) administration of GM6001 (a MMPs inhibitor) or the NGF mimetic peptide BB14 modulate these events. Immunohistochemical analysis of spinal cord sections revealed that motor neuron disease following SNI was associated with increased microglial (Iba1) and astrocytic (GFAP) response in the ventral horn of the spinal cord, indicative of reactive gliosis. These changes were paralleled by decreased glial aminoacid transporters (glutamate GLT1 and glycine GlyT1), increased levels of the neuronal glutamate transporter EAAC1, and a net increase of the Glutamate/GABA ratio, as measured by HPLC analysis. These molecular changes correlated to a significant reduction of mature NGF levels in the ventral horn. Continuous i.t. infusion of both GM6001 and BB14 reduced reactive astrogliosis, recovered the expression of neuronal and glial transporters, lowering the Glutamate/GABA ratio. Inhibition of MMPs by GM6001 significantly increased mature NGF levels, but it was absolutely ineffective in modifying the reactivity of microglia cells. Therefore, MMPs inhibition, although supplies neurotrophic support to ECM components and restores neuro-glial transporters expression, differently modulates astrocytic and microglial response after PNI. Copyright