Sudden hearing loss in childhood consequent to hepatitis B vaccination: a case report.
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Child↗
Biomedical subjects
A Ciofalo
Publications and source records attributed to A Ciofalo.
Screening patients affected by common variable immunodeficiency.
Chronic immunoglobulin administration decreases the incidence of bronchial and pulmonary infections in patients affected by chronic variable immunodeficiency (CVI). In this study, an ENT screening was carried out in 22 patients affected by chronic variable immunodeficiency and treated with chronic immunoglobulin administration. All the patients underwent ENT physical examination, nasal endoscopy by fiberoptics, mucociliary transport test (MTT), anterior rhinorheomanometry (RRM), nasal provocation test with cold water (ANPT), audiometry and impedentiometry, olfactory evaluation, and paranasal sinus X rays. Dysphagia was present in 91% of the patients, nasal secretion and obstruction in 77%, and hypoacusia, tinnitus, and otodinia in 57%. Rhinitis and pharyngitis were observed in 86% of the patients, and serous middle ear effusion in 50%. Confirmed maxillary sinusitis was observed in five patients. Hyposmia was observed in 50% of the patients. MTT was significantly longer in the patients than in the controls (18.0 +/- 10.5 vs. 11.2 +/- 2.4 min; p < .05). Nasal resistance was lower in patients than in controls (0.46 +/- 0.32 vs. 1.11 +/- 0.22 Pa/L.s-1; p < .001). ANPT was positive in 9 patients out of 25 versus 1 control out of 15 (p < .05). Finally, seven patients were affected by transmissive hypoacusia, and one patient by neurosensorial hypoacusia. Our results suggest that chronic immunoglobulin administration in CVI patients is not effective against ENT disorders, probably because of the important role played by nasal hyperreactivity. Frequent ENT examination and early treatment of ENT disorders are therefore suggested in order to prevent chronic disease.
Adolescent↗
Intranasal immunotherapy with Dermatophagoides extract: in vivo and in vitro results of a double-blind placebo-controlled trial.
Intranasal immunotherapy (IT) has been proposed as a means to induce an effective immunity of the nasal mucosa in patients with allergic rhinitis, avoiding systemic side effects. In the present study 20 individuals with chronic allergic rhinitis, and skin prick test reactive to Dermatophagoides pteronyssinus (DP) only, were randomized and subjected to a three months' double-blind placebo-controlled trial of intranasal IT with DP extract. All patients received also sodium cromoglycate as pre-medication. Before and at the end of the treatment the patients performed specific nasal provocation tests, and samples of serum and nasal secretions were collected to measure total and specific IgE, levels of eosinophil cationic protein (ECP), and mast-cell-derived tryptase. A clinical score was computed by the symptoms indicated by the patients. The clinical score did not change in the two groups after the treatment, whereas a decrease in nasal reactivity was observed. Total IgE increased only in secretions from placebo-treated patients, but were not modified in sera. IgE to DP in sera and nasal secretions did not change significantly. Tryptase levels in nasal secretions decreased in both groups, while ECP was unchanged after IT. Serum ECP levels decreased more in actively treated patients than in the placebo group. The data suggest that changes of IgE and inflammatory mediators may be affected by the use of sodium cromoglycate in both groups, but some parameters change early in different directions in IT- and placebo-treated groups.
Administration, Intranasal↗
Recurrent inflammatory myofibroblastic tumor of the glottis mimicking malignancy.
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Diagnosis, Differential↗
Otorhinolaryngological aspects of HIV infections: personal experience.
The involvement of the ENT sphere in HIV infections is fairly common, but the relative manifestations, though not to be considered atypical, are not pathognomonic. The present study has been set up for the otoiatric assessment of a group of HIV patients and the correlation of ENT symptoms with the various stages of the disease. To this end, 60 patients were examined (35 belonged to groups 2-3 and 25 to group 4) of whom 50% were drug addicts, 36% homosexuals and 14% heterosexuals. All patients underwent a complete ENT examination as well as the assessment of hearing and vestibular function, of olfactory and taste functions, of respiratory and nasal mucociliary functions along with an anti-HIV antibody check of nasal secretion. Results showed a prevalence of otologic and rhinosinusal symptoms as well as cervical-facial swelling. Testing revealed a hearing loss of mainly conductive origin caused by otitis and tubal stenosis; vestibular hyporeflexia; mixed hyposmia and hypogeusia owing to the involvement of multiple cranial nerves; respiratory and mucociliary changes due to rhinitis and hypertrophy of the nasal mucosa. In all cases anti-HIV antibodies were found in nasal secretion. From a diagnostic point of view there was a prevalence of specific pathologies: oropharyngeal candidosis, stage 4; cervical lymphoadenopathy, stages 2-3; chronic rhinosinusitis, nasal vestibulitis and nosebleed; mainly chronic otitis media. All such manifestations suggest a marked involvement of ENT organs, which can be attributed to the anatomical characteristics of the area, with the relative diagnostic and prognostic implications of HIV infection.
AIDS-Related Opportunistic Infections↗
Local treatment of aspecific nasal hyperreactivity with capsaicin.
Ten patients with vasomotor rhinitis underwent local treatment with capsaicin (30 micromol.), once per week for five weeks; controls were carried out at weekly intervals and 1, 3 and 6 months after therapy. Assessment was made using symptom score and nasal resistance scores both basal and subsequent to aspecific nasal provocation. Results showed abatement of symptoms, and reduction of nasal resistance and aspecific hyperreactivity already during the second week. This trend continued for six months, with endoscopic improvement also. Hence, this treatment proved to be efficient in reducing nasal reactivity.
Adolescent↗
Local treatment of nasal polyposis with capsaicin: preliminary findings.
The inflammatory process triggered by the nasal hyperreactivity, whether specific or aspecific, presents three components: immunomediation-neurogenic-interconnection between the nervous and the immunitary systems. Neuropeptides (eg SP and CGRP) are among the agents responsible for neurogenic phlogosis and, in our opinion, they contribute towards the onset of polyps. Capsaicin, which acts on the C fibres, has been applied locally (30 microns) by the AA in 15 patients affected by aspecific nasal hyperreactivity with polyps, in the course of a double blind study with an equal number of patients. Treatment was given once a week for 5 consecutive weeks in order to evaluate the effect on both the hyperreactivity and the polyps. Before and after each session and at the 1- and 3-month controls the following tests were carried out: assessment of symptoms, nasal endoscopy, sizing of the polyps, aspecific nasal provocation test and nasal cytology. Apart from an improvement in symptoms and in nasal hyperreactivity, results showed a reduction in the size of the polyps even though accompanied by a gradual increase of eosinophiles which was not correlated to a degranulation process.
Adult↗