Papers by Valerio Damiani
European Journal of Rhinology and Allergy
Monaldi Archives for Chest Disease, 2021
Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a common disorder. From a clinical and im... more Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a common disorder. From a clinical and immunopathological point of view, different phenotypes and endotypes have been identified. As asthma is frequent comorbidity, biological agents for treating CRSwNP associated with asthma may be an attractive strategy. Biological agents have several mechanisms, such as antagonizing IgE, interleukin (IL) 4, IL-5, and IL-13. However, a workup is mandatory, mainly concerning pheno-endotyping. In this regard, clinical cytological grading (CCG) has been proposed as a useful tool to manage patients with CRSwNP as it allows us to define clinical and immunopathological phenotypes able to identify the ideal candidate for biologics. In particular, the mixed cellular pattern, such as eosinophils and mast cells, could be sensitive to anti-IL-4 agents. There is still a need for well-established indications, criteria of responsiveness, duration, and safety. Moreover, personalized medicine could be opport...
Acta bio-medica : Atenei Parmensis, 2020
Laryngopharyngeal reflux (LPR) is a common disorder. Pepsin has been detected also at eye level, ... more Laryngopharyngeal reflux (LPR) is a common disorder. Pepsin has been detected also at eye level, this was a starting point for newest theories about LPR impact on Dry Eye Syndrome. The current preliminary study compared two treatments in patients with Dry Eye Syndrome and LPR. Patients were treated with Gastroftal eye drops and Gastroftal tablets or hyaluronic acid eye drops for 3 months. The following parameters were evaluated: Ocular Surface Disease Index (OSDI), OSDI categories, Reflux Symptom Index (RSI), Reflux Finding Score (RFS), Fluorescein Tear Breakup Time (B-TUT), and Schirmer test before and after treatment. On the whole, 21 patients were enrolled: 10 were treated with hyaluronic acid Atlantis (Group A) and 11 with Gastroftal eye drops and tablets (Group B). After treatment, in Group A only OSDI significantly diminished (p=0.029); in Group B there were significant reductions concerning OSDI (p=0.0277), OSDI categories (p=0.0211), RSI (p=0.0172), Schirmer test (p=0.0172),...
Expert Review of Clinical Immunology, 2020
ABSTRACT Introduction Children with recurrent respiratory infections (RRI) represent a social iss... more ABSTRACT Introduction Children with recurrent respiratory infections (RRI) represent a social issue for the economic burden and the negative family impact. Local Bacteriotherapy is an attractive therapeutic strategy that could be potentially effective in preventing infections. The current article remarks on the existing evidence of preventing RRI by Local Bacteriotherapy. Areas covered The literature search methodology was based on the articles cited by PubMed from 1980 to 2020. Respiratory infections include rhino-pharyngitis, otitis media, rhinosinusitis, pharyngo-tracheitis, bronchitis, and pneumonia. Several studies were performed to investigate the effects of Local Bacteriotherapy in children with RRI. Both intranasal and oral Local Bacteriotherapy were evaluated. The findings showed that Local Bacteriotherapy significantly reduced the number of RI episodes, their severity, the use of antibiotics, and school absences. Expert opinion Local Bacteriotherapy is a promising approach to RRI prevention and could be a profitable strategy to contrast infections in the future.
Journal of biological regulators and homeostatic agents, 2021
Allergic rhinitis (AR) is a frequent disease caused by an IgE-mediated inflammation of the nose a... more Allergic rhinitis (AR) is a frequent disease caused by an IgE-mediated inflammation of the nose and characterized by typical symptoms. Diagnostic workup is directed to document the production of specific IgE (sensitization). Clinical management aims to relieve symptoms, resolve allergic inflammation, use medications, and potentially induce allergen tolerance, using allergen immunotherapy (AIT). The current survey was conducted in 17 International ear nose throat experts using a questionnaire with 20 questions concerning the practical management of AR patients. It was administered in the 2020 summer. The large majority (94%) of participants use the ARIA classification in clinical practice. On average, subjects with suspected AR represent half of the patients who turn to the ENT experts; 80% have the confirmed diagnosis. Most of the experts use both cutaneous and serum assay to document IgE production. Antihistamines are prescribed in 59% of AR patients, intranasal corticosteroids in ...
Acta bio-medica : Atenei Parmensis, 2020
Allergic rhinitis (AR) is caused by an IgE-mediated inflammatory reaction consequent to the expos... more Allergic rhinitis (AR) is caused by an IgE-mediated inflammatory reaction consequent to the exposure to the causal allergen. Glycyrrhetic acid (GlyAc) is a natural compound extracted from the liquorice that exerts anti-inflammatory activity. This real-life study compared intranasal GlyAc, present in a medical device containing also glycerol and mannitol, with mometasone furoate nasal spray (MFNS) in 50 adult outpatients with AR. Both treatments lasted 2 months. Endoscopic signs, perception of symptom severity, assessed by VAS, and nasal function measured by rhinomanometry were evaluated at baseline (T0), after one (T1) and two (T2) months. The intergroup analysis showed that at T1 there was no significant difference between groups about the use of decongestants and antihistamines, turbinate hypertrophy and pale mucosa, perception of olfaction and snoring. At T2 there was no significant difference between groups about use of relievers, all endoscopic signs, and perception of nasal di...
Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale, 2008
Microvascular free-flaps have been in clinical use for nearly 3 decades becoming the gold standar... more Microvascular free-flaps have been in clinical use for nearly 3 decades becoming the gold standard in oral and oropharyngeal reconstruction. In this study, a comparison has been made between the radial forearm fasciocutaneous flap with the thinned anterolateral thigh cutaneous flap (tALT), showing the advantage of the anterolateral thigh cutaneous flap in oral and oropharyngeal reconstruction. Between January 2003 and January 2007, 48 reconstructions were performed in patients submitted to surgery for oral and oropharyngeal carcinoma using, in 17 cases, a radial forearm fasciocutaneous flap and, in 31, an anterolateral thigh cutaneous flap. In patients treated with the radial forearm fasciocutaneous flap, results showed 94.1% flap survival; in cases treated with the anterolateral thigh cutaneous flap, 93.5% flap survival (p < 0.9). Functional results, at receiving site, were comparable in both groups. Functional results, at donor site, were less successful in the radial forearm f...
Expert Review of Clinical Immunology, 2020
Introduction: High mobility group protein box 1 (HMGB1) is a protein belonging to the alarmin fam... more Introduction: High mobility group protein box 1 (HMGB1) is a protein belonging to the alarmin family. HMGB1 has a relevant role in starting the inflammatory cascade by means of receptors, such as RAGE and TLR. HMGB1 supports transcription of many genes in interactions with many transcription factors, including NF-kB. The axis HMGB1-RAGE-NF-kB has, therefore, a pivotal role in the inflammatory cascade. HMGB1 controls the production of several pro-inflammatory cytokines and the proliferation and activation of many inflammatory cells. Areas covered: The present report concerns the role of HMGB1 in nasal inflammatory disorders, including allergic and non-allergic rhinitis, and chronic rhinosinusitis with nasal polyps. HMGB1 modulation has been the aim of several studies. The literature search included recent papers that covered this topic. Expert opinion: As HMGB1 has a pivotal role in inflammatory events, its modulation could be attractive for designing new therapeutic strategies. In this regard, glycyrrhetic acid (GA), the active component of Glycyrrhiza glabra, can efficiently block HMGB1. Promising reports seem to suggest that GA could exert favorable anti-inflammatory activity in patients with nasal inflammatory disorders.
Oto-Rhino-Laryngologia Nova, 2003
The therapeutic rationale of acute or chronic rhinosinusal inflammatory disease must necessarily ... more The therapeutic rationale of acute or chronic rhinosinusal inflammatory disease must necessarily be based on the correct identification of the microbiological agents involved in causing the sinus affection. In our experience, Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis are the germs responsible for most of the acute forms found in our country, in adults and children alike. In 1997, the FDA approved the use of antibiotics such as amoxicillin/clavulanic acid, clarithromycin, cefuroxime axetil, loracarbef and levofloxacin for acute forms. According to our experience, the administration of amoxicillin/clavulanic acid would appear to be particularly effective, also in the relapse of chronic forms. Regarding the duration of antibiotic treatment, consensus is practically unanimous. In acute rhinosinusitis, the therapy should be given for at least 10 days at full dosage. The duration of treatment may be extended up to 14 days at the physician’s discretion in t...
Lung Biology in Health and Disease, 2005
Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy Reviews, 2003
ABSTRACT The relapse of nasal polyps after surgical treatment remains a yet unsolved medical prob... more ABSTRACT The relapse of nasal polyps after surgical treatment remains a yet unsolved medical problem and, at the same time, a challenge for researchers. Starting from the observation that oedema, vessel dilatation and inflammatory cell infiltration are the histopathological characteristics of nasal polyps, our aim is to demonstrate the long-term efficacy of furosemide, administered by nasal inhalation, in preventing relapses of rhino-sinusal polyps after surgical treatment. In the study discussed in this paper, two groups of patients affected by rhino-sinusal polyposis were enrolled: 64 patients were included in the study group and 40 in the control group. After surgical treatment, the study group started the therapy with topic intranasal furosemide; the control group received no treatment. Six years after the operation only four cases of relapse were noticed in the study group (10%), while in the control group there were 12 relapses, four slight (6.4%) and eight severe (20%). Our paper concludes that local intranasal furosemide represents a valid therapeutic aid in the prevention of naso-sinusal polyps.
International Journal of Pediatric Otorhinolaryngology, 2004
Objective: to evaluate the relationships between headache and nasal obstruction or nasal allergy ... more Objective: to evaluate the relationships between headache and nasal obstruction or nasal allergy on a group of Italian school children. Methods: One hundred twenty-six children suffering from headache, were enrolled in the study. All patients underwent an accurate clinical history, a complete ENT objective examination, an Anterior Active Rhinomanometry, an analysis of nasal mucociliary transport time and a skin test on the inner forearm. Results: Nasal resistances were increased in 101 out of 105 of children (96.2%) affected by severe headache (group A) and in 5 out of 21 (23.8%) of those affected by sporadic headache (P < 0.0001), for an odds ratio of 80.0 (95% CI, 19-343). The analysis of mucociliary transport time offered results comparable with those of the Anterior Active Rhinomanometry. Conclusions: Dysfunctions of nasal physiology, as stated by the alteration of nasal resistances and nasal mucociliary transport, seem to be able to affect the development and the characteristics of headaches; specifically we found that children with an altered nasal physiology have more severe and more frequent attacks of headache.
Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy Reviews, 2003
ABSTRACT To date, several aspects of allergic rhinitis remain controversial. In particular, data ... more ABSTRACT To date, several aspects of allergic rhinitis remain controversial. In particular, data concerning its epidemiological evolution are extremely contradictory and vary between negation and assertion of an increased prevalence within the last decade. In the study discussed in this paper, our aim was to follow the evolution of allergic rhinitis in three different territorial areas of Central Italy in the last 20 years and to analyse the long-term efficacy of treatment. Between 1980 and 1981, 1620 children, attending seven state schools (four elementary and three lower secondary), were screened for allergic rhinitis. All children underwent a skin test on the inner forearm. Positive-skin-test children were examined to specify the exact nasal allergy. Between 1998 and 1999, positive-skin-test patients were contacted and re-examined. The results revealed that elementary school children showed lower degrees of skin positivity, a better nasal patency, a more efficient nasal clearance and less frequent anomalous radiological findings. Seventy-three children were positive to skin tests (4.5%). Forty-six positive-skin-test subjects were re-examined: 21 recovered, 12 were unchanged, 10 developed complications, three become asthmatics. Twenty-one subjects had not received any treatment, 15 were treated with symptomatic drugs, and 10 with immunotherapy. Our study showed an increased prevalence of allergic rhinitis in the last 20 years of the 20th century, with a jump from 4.5 to 10–20%; moreover, it showed that immunotherapy guarantees remission of local symptoms and valid protection against localized and bronchial complications. Symptomatic treatment with antihistamines and/or corticosteroids, although not always resolutive, represents a valid alternative.
Open Medical Devices Journal, 2012
Rationale and aim: Nasal congestion is a common symptom in rhinologic diseases such as rhinosinus... more Rationale and aim: Nasal congestion is a common symptom in rhinologic diseases such as rhinosinusitis, nasal polyposis and adenoid pathology. Although various pharmacotherapy options exist, no agent is universally efficacious. The aim of this study was to evaluate the efficacy of Narivent ® , an osmotically acting medical device with antioedematous and anti-inflammatory effects, in a short-term (7days) treatment. Methods: A single-centre prospective study with a pre-post design was conducted with consecutive enrolment in an Italian Otolaryngology Department of 36 both genders patients with nasal congestion. Patients received 2 puffs of Narivent ® into each nostril 2 times a day over the course of 1 week. The severity of symptoms was assessed subjectively as measured by a 0 to 10 visual analogue scale (VAS) and the presence/absence of symptoms and signs. Differences in subjective and objective severity measures before and after treatment were compared using Paired-Sample Wilcoxon Signed Rank Test. Results: A significant improvement after treatment (p<0.001) has been recorded for the main subjective symptoms and objective signs (overall symptom burden, nasal congestion, cephalea, turbinates hypertrophy, normal mucosa status). Conclusion: Study results confirm the efficacy of Narivent ® in treating nasal congestion over a 1 week period.
Open Medical Devices Journal, 2012
Rationale and aim: Upper airway disorders, like allergic and non-allergic rhinitis, are common na... more Rationale and aim: Upper airway disorders, like allergic and non-allergic rhinitis, are common nasal conditions affecting millions of individuals worldwide. The prevalence of allergic rhinitis (AR), in particular, has been increasing in the last decades. The pervasiveness of this disorder therefore imposes a large burden both on individual patients and the society. A wide range of drugs exists for symptomatic treatment of rhinitis, such as corticosteroids, decongestants, and antihistamines, but standard therapies are often associated with several side effects. A new class of medical devices, based on bio-mechanically innovative triggers, has been proven to have a good clinical effectiveness with lower adverse reactions, particularly over prolonged administration periods. The present study aims at evaluating the economic impact of rhinitis, with respect to direct and indirect costs, and analysing the use of the medical device Narivent ® compared to standard therapies to manage the symptoms of this illness. Methods: Via a Monte Carlo simulation study, data on disease prevalence, drug prescription and cost of both the specific therapeutic approach and the adverse events treatment will be combined to provide an estimate of the overall cost of the pharmacotherapy as compared with Narivent ®. Results: Lowering the impact of adverse reactions related to standard therapy through the use of novel therapeutic approaches like Narivent ® , might reduce the overall burden of rhinitis by about 5 billion per year. Conclusion: The use of the medical device Narivent ® , as an alternative approach to manage symptoms associated with rhinitis, may contribute to bring down its costs by about 3.5% yearly as compared to the standard therapy.
International Journal of Pediatric Otorhinolaryngology, 2009
The aim of the present study is to discuss the basics of atopy in children in relationship to the... more The aim of the present study is to discuss the basics of atopy in children in relationship to the principal ENT allergic disorders such as allergic rhinitis, rhinosinusitis and their impact on lower airways, allergic otitis media, and oral cavity focusing on their natural history. Methods: An updated and exhaustive review of principal literature on these topics is performed, underlining the constant but growing interest evoked by these disorders most of all the possible sequelae or complications. Considering the different districts which can be selectively or simultaneously affected by the allergic sensitisation, diagnosis can be a really hard task; in this paper, we tried to draw an integrated diagnostic approach to atopic children and some guidelines for a correct therapeutic approach. Conclusions: Atopic disorders could expose young patients to years of chronic diseases that interferes with their development and with many important aspects of their lives. For these reasons, and considering the high social and medical costs of this disease, it is extremely important to adequately treat allergic pathologies from the early phases of its natural history. Moreover, we cannot forget that an appropriate therapy of allergic pathologies should not be only able to decrease symptoms but, it should also be able to improve patients health related quality of life.
Journal of International Medical Research, 2012
Objective: Nasal congestion is a common symptom in allergic and nonallergic rhinitis, rhinosinusi... more Objective: Nasal congestion is a common symptom in allergic and nonallergic rhinitis, rhinosinusitis and nasal polyposis. The present study evaluated the clinical effectiveness of Narivent®, an osmotically-acting medical device with anti -oedematous and anti-inflammatory effects, in nasal congestion. Methods: A single-centre, prospective study with a pre- post design and consecutive patient enrolment was conducted in an Italian otolaryngology department. Patients with persistent nasal congestion were allocated to treatment groups as follows: group 1 ( n = 36) treated for 7 days; group 2 ( n = 56) treated for 30 days. In each group, patients received two puffs of Narivent® into each nostril twice daily. Symptom severity was assessed subjectively on a 0 - 10 visual analogue scale, and objectively by the presence/absence of signs and symptoms. Differences in subjective and objective severity measures before and after treatment were compared using Wilcoxon's signed rank test. Result...
International Congress Series, 2003
Purpose: To evaluate modifications of moxifloxacin (MFX) concentrations in tonsillar tissue and p... more Purpose: To evaluate modifications of moxifloxacin (MFX) concentrations in tonsillar tissue and plasma up to 24 h after three oral doses of 400 mg, and to assess the safety and tolerability of this drug in adult patients with chronic or recurrent tonsillitis undergoing tonsillectomy. Methods: Twenty-nine patients with normal renal and hepatic function were randomly placed into five groups according to the time between the last moxifloxacin dose administered and the time of sampling (group A: 2 h, group B: 3 h, group C: 6 h, group D: 12 h, group E: 24 h). Plasma, from heparinized venous blood, and tissue concentrations were determined using a validated HPLC assay with fluorescence. Results: Mean levels of moxifloxacin in the tonsillar tissue were on average at least 2fold with respect to the correspondent values in the plasma. The time profile in tissue seems to be very similar to that in plasma. In particular, the peak concentration in the tissue occurred at the same time (hour 3) as in plasma, having a ratio of about three (2.85) in favour of the tissue mean level. No drug-related adverse effects developed in any of the patients. Conclusions: Moxifloxacin was well tolerated by all patients and achieves a good penetration in tonsillar tissue, which compares favourably with that reported for other fluoroquinolones.
International Congress Series, 2003
Objective: To evaluate certain infectious, structural and immunological aspects of the adenoids a... more Objective: To evaluate certain infectious, structural and immunological aspects of the adenoids and tonsils in patients submitted to adenotonsillectomy due to chronic inflammation or massive hypertrophy. Materials and methods: In the first phase, bacterial flora and lymphocytic population were analyzed in the tonsils and adenoids removed from 19 children; in the second phase, histological studies and analysis of the cytokine pattern were carried out in palatine tonsils and adenoids from 105 patients submitted to adenoidectomy and bilateral extracapsular tonsillectomy. Results: The presence of Haemophilus influenzae, Streptococcus pneumoniae and S beta-hemolytic was comparable in both tissues; the most frequently isolated pathogen being H. influenzae. A higher percentage of T3 and T4 lymphocytes was observed in adenoids than in the tonsils. Histologically, of the 105 cases examined, 46 presented hyperkeratosis of the crypt epithelium; in the remaining 59, the epithelium was hyperplastic with no signs of keratosis. A comparison of findings, in serum and tissues, showed a higher concentration of interleukin (IL)-1h and tumor necrosis factor-alpha (TNFa) in the adenotonsillar specimens, whereas the rise in IL-6 was more modest. Conclusions: The impaired immunological reactivity of the tonsils would appear to be mediated by a change in the epithelial compartment which results in impaired antigen uptake rather than by the lymphatic compartment which only reacts to the repeated stimuli. The high levels of cytokines lead, with repeated infectious stimuli, to activation and proliferation of endothelial cells and fibroblasts which result, with time, in the progressive replacement of immunologically active tissue with fibrotic tissue which is, therefore, immunologically silent.
European Archives of Oto-Rhino-Laryngology, 2003
The aim of the present work was to analyse the alterations of rhino-sinusal physiology in 106 pro... more The aim of the present work was to analyse the alterations of rhino-sinusal physiology in 106 professional athletes (swimmers, skiers, boxers and runners) using objective rhinological methods. Every athlete underwent an accurate anamnesis, a complete objective ORL evaluation, an active anterior rhinomanometry, an acoustic rhinometry and an evaluation of mucociliary transport time (MCTt). Skiers were also submitted to a nasal decongestion test (NDT). In swimmers, the mean MCTt was 27.4± 4.97 min (normal value: 13±3 min; P<0.0001). The average MCTt for the skier group was 19.58±1.92 min (P< 0.0001); the mean value of total basal nasal resistance was 0.37±0.05 Pa/ml per s (normal value =0.25 Pa/ml per s; P<0.001). After NDT, total nasal resistance was 0.18± 0.02 Pa/ml per s. In the group of boxers, the total mean nasal resistance was 0.64±0.05 Pa/ml per s (P<0.001); the mean cross-sectional area at the nasal valve level was 0.57±0.04 cm 2 (normal value =0.55±0.05 cm 2) and at the inferior turbinate level 0.83±0.05 cm 2 (normal value =0.4± 0.04 cm 2 ; P<0.001); the TMC average time was 27.35± 2.21 min (P<0.0001). Finally, for the runners, the mean MCT time was 20.56±2.35 min (P<0.001). Knowing the alterations of the physiological nasal respiration is of extreme importance to develop a correct and timely therapeutic approach to be able to restore rhino-sinusal homeostasis. Athletes, in fact, need the earliest therapeutic aid in order to avoid the interference of prolonged rhino-sinusal alterations with their performance and also to avoid a more serious clinical situation concerning the inferior airways.
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Papers by Valerio Damiani