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Aging is a progressive and multifaceted event, which involves all the cells and organs of the human body. In this chapter we will try to analyze how the senses of smell and taste change with age. Anatomical and physiological modifications of the nose and salivary glands will be described, as well as changes in structures of the Central Nervous System and neurochemical processes that underlie these two senses. Finally, we will discuss the effect of many senile age drugs and chemo- radiotherapy on the perception of smell and taste, as well as the impact of chronical diseases on these senses.

Secretory senescence of the upper and lower airway represents the most important risk factor for respiratory complication in the elderly. In most cases, patients present with high health care costs due to the relevant number of hospitalizations and medical cares. A growing evidence is accumulating on the role of immunosenescence in the pathogenesis of chronic rhinosinusal disorders, and on defect in the lubrication of the corneal, conjunctival and scleral mucosa, delicate structures of the external eye, and of trachea-bronchial diseases, dependent on a failure of the gland system and reduction of mucociliary clearance (MCC). The presence of multiple comorbidities in the elderly may significantly contribute to a systemic pro-inflammatory state which negatively affects the airway. Secretory senescence promotes systemic inflammation and exacerbates the pre-existing pathologies. The role of cytokines is associated to a pro-inflammatory state of breathing apparatus. Several observations support the hypothesis that the secretory senescence can act in a paracrine and vasocrine manner to influence the structure and function of glands, mucus and lacrimal secretions, thus contributing to fraility and hospitalizations in the elderly. Given the recognized role of secretory senescence in the pathophysiology of airway disease, it should be desirable to identify specific therapies targeting the nasal, lacrimal and tracheo- bronchial secretory system able to modulate its pro-inflammatory profile and the negative effect of the inflammatory burden on the elderly.

The vestibular and cochlear senescence is a complex degenerative disease and one of the most prevalent chronic conditions of elderly, affecting tens of millions of people worldwide. In this review, we will try to summarize the most important sites and involved mechanism trying to figure out strategies to prevent its clinical consequences.

SARS-CoV19 is spreading all over the world starting from China in the end of 2019. This important emergency involved every single aspect of ordinary life. Even hospitals have undergone changes with the aim of ensuring the best care and preventing the spread of the virus. This is a personal contribution to illustrate all the measures put in place to avoid contagion. Although in an ENT unit you have strictly to do with the airway, none of the staff so far has been positive. Keyword: SARS-CoV19, safety, prevention, ENT, contagion.

Chronic rhinosinusitis (CRS) includes two main phenotypes: without nasal polyps (CRSsNP) and with nasal polyps (CRSwNP). CRSwNP may be associated with comorbidity, mainly concerning asthma, aspirin intolerance, and allergy. CRSwNP patients may also be evaluated by clinical-cytological grading (CCG). The current study investigated the prevalence and characteristics of the different CCG and phenotypes in CRSwNP outpatients examined in clinical practice. This retrospective cross-sectional study enrolled 791 consecutive CRSwNP outpatients (424 males, mean age 48.8 years). In the total population, asthma was a common comorbidity (30.8%) as well as aspirin intolerance (24.8%), and allergy (50.8%). As concerns CCG-grading, 210 (26.5%) outpatients had low-grade, 366 (46.3%) medium, and 215 (27.2%) high. As regards cytological phenotypes, 87 (11%) had neutrophilic type, 371 (46.3%) eosinophilic, 112 (14.2%) mast cell, and 221 (27.9%) mixed. High-grade CCG was significantly associated with more frequent asthma, aspirin intolerance, allergy, recurrent surgery, and mixed cytological phenotype. Low-grade CCG was characterized by fewer comorbidities and operations, and neutrophilic phenotype. Therefore, the present study confirmed that CCG is a useful tool in the management of outpatients with CRSwNP. CRSwNP is frequently associated with asthma, aspirin intolerance, and allergy comorbidity. High-grade CCG is frequently characterized by a mixed cytological phenotype, thus, by more severe progress. These real-world outcomes underline that CRSwNP deserves adequate attention for careful management and optimal identification of the best-tailored therapy; CCG and cytological phenotyping could be fruitful tools in clinical practice. Asthma and aspirin intolerance should be adequately investigated in all CRS patients.

Saliva is an essential body fluid. It is important in maintaining oral health, taste acuity, mastication, deglutition, digestion, regulation of oral flora, oral cleansing, voice acuity, and speech articulation. In the elderly, the glandular parenchyma undergoes involution of the cellular component, and this leads to a reduction in the production of saliva. Qualitative and quantitative alterations of this biological fluid can cause patient discomfort and quality of life decline. This often translates into xerostomia, whose real meaning is mouth dryness. We will discuss here causes of xerostomia in the elderly, such as drugs, head and neck radiotherapy, and autoimmune diseases.

Background The parapharyngeal space (PPS) can harbor a variety of tumors that can be approached through a wide spectrum of surgical routes. A decisional algorithm on the surgical approach to resect PPS lesions was tested in terms of reliability by retrospectively applying it to a large series of patients. Methods Patients treated at the Unit of Otorhinolaryngology – Head and Neck Surgery of the University of Brescia, Italy, for tumor or tumor-like lesions involving the PPS between October 1986 and July 2019 were included in the retrospective analysis. Tumor characteristics, clinical presentation, diagnostic work-up, type of resection, surgical approach, and oncologic and morbidity outcomes were reviewed. Reliability of the algorithm was calculated as the number of cases in which the expected approach was confirmed/total number of cases × 100. Results The analysis included 153 patients. Most lesions (64.1%) were benign. The most frequent complaint at presentation was unilateral oropharyngeal medialization (47.1%), followed by neck/parotid swelling (41.2%). Ninety-two (61.3%) lesions were excised through an enucleation/extracapsular dissection. Wide-margin resection and compartmental resection were performed in 17 (11.3%) and 41 (27.3%) patients, respectively. A single-corridor approach was employed in 132 (87.4%) cases. Combinations of multiple corridors were adopted in 19 (12.6%) patients. Reliability of the decision-making algorithm was 91.2%. Capsular integrity and margin status affected prognosis of pleomorphic adenomas and PPS malignancies, respectively. Conclusion The proposed decision-making algorithm can reliably guide approach selection, which should primarily aim at ensuring intact-capsule excision of benign lesions suspicious for pleomorphic adenomas and clear-margins resection of PPS malignancies.