TROZZI MARILENA

Scopus Publications

Pediatric Tracheostomy Emergency Readiness Assessment Tool: International Consensus Recommendations
Elliot Schiff, Evan J. Propst, Karthik Balakrishnan, Kaalan Johnson, David W. Lounsbury, Michael J. Brenner, Marc‐Mina Tawfik, Jeffrey P. Simons, Eric Moreddu, Briac Thierry, Eric Gantwerker, David R. White, Paul Hong, Margo K. McKenna, David W. Molter, Marlene Soma, Mike J. Rutter, Neha A. Patel, Stephen R. Chorney, Liane B. Johnson, John D. Prosser, Douglas R. Sidell, Gresham T. Richter, Brandon S. Hopkins, Marc Gibber, Clarice Clemmens, Soham Roy, Derek J. Lam, Sukgi Choi, Jason May, Matthew T. Brigger, Craig S. Derkay, Wei‐Chung Hsu, Scott Schraff, Johnathan D. McGinn, Jonathan B. Ida, Michel Nassar, Joshua R. Bedwell, Reza Rahbar, Michele Torre, Scott E. Mann, David A. Zopf, Robert Chun, Erynne A. Faucett, Maja Svrakic, Sam J. Daniel, Mathieu Bergeron, Seth M Pransky, Lyndy J. Wilcox, Nira A. Goldstein, Romaine F. Johnson, Michael E. McCormick, Catherine K. Hart, Kara K. Prickett, Sanjay R. Parikh, Lily H.P. Nguyen, Marilena Trozzi, Glenn E. Green, Jeremy D. Prager, Gene Liu, Meredith N. Lind, John Dahl, Lauren A. Bohm, Katherine R. Kavanagh, Deepak Mehta, Ravindhra G. Elluru, Neil Bateman, Kara D. Meister, Josh Wiedermann, Ryan Belcher, John Russell, Jonathan Walsh, James Kearney, Richard Nicollas, Prasanth Pattisapu, Karen Watters, Mark E. Gerber, Kelly M. Malloy, Tiffany P. Raynor, Elliot Regenbogen, R. Paul Boesch, Pierre Fayoux, Sohit P. Kanotra, John Jack Manoukian, Trina C. Uwiera, Alanna M. Windsor, Michael S. Weinstock, Taher Valika, Hamdy El‐Hakim, Benjamin E. Hartley, Jorge E. Spratley, Shazia Peer, Claire M. Lawlor, Jean‐Philippe Vaccani, Clare M. Richardson, Carlton J. Zdanski, Jill Jeffe, Kishore Sandu, John M. Carter, Ann W. Plum, Scott Rickert, Luv R. Javia, Jennifer Lavin, Charles M. Myer, Nikhila P. Raol, Joseph Piccione, Ernest D. Gomez, Nicholas J. Smith, Nancy Bauman, Catherine Doherty, Noel Jabbour, Lindsay Sobin, Matthew Bromwich, Brendan A. McGrath, Udayan K. Shah, Robin T. Cotton, Murad Husein, Marie Eva Rossi, Alessandro de Alarcon, Mark Volk, Robert F. Ward, April Landry, Tsung‐yen Hsieh, Richard J. Smith, Phillip Losavio, Christina J. Yang, and
Laryngoscope, ISSN: 0023852X, eISSN: 15314995, Published: 2023 Wiley
OBJECTIVE To achieve consensus on critical steps and create an assessment tool for actual and simulated pediatric tracheostomy emergencies that incorporates human and systems factors along with tracheostomy-specific steps. METHODS A modified Delphi method was used. Using REDCap software, an instrument comprising 29 potential items was circulated to 171 tracheostomy and simulation experts. Consensus criteria were determined a priori with a goal of consolidating and ordering 15 to 25 final items. In the first round, items were rated as "keep" or "remove". In the second and third rounds, experts were asked to rate the importance of each item on a 9-point Likert scale. Items were refined in subsequent iterations based on analysis of results and respondents' comments. RESULTS The response rates were 125/171 (73.1%) for the first round, 111/125 (88.8%) for the second round, and 109/125 (87.2%) for the third round. 133 comments were incorporated. Consensus (>60% participants scoring ≥8, or mean score >7.5) was reached on 22 items distributed across three domains. There were 12, 4, and 6 items in the domains of tracheostomy-specific steps, team and personnel factors, and equipment respectively. CONCLUSIONS The resultant assessment tool can be used to assess both tracheostomy-specific steps as well as systems factors affecting hospital team response to simulated and clinical pediatric tracheostomy emergencies. The tool can also be used to guide debriefing discussions of both simulated and clinical emergencies, and to spur quality improvement initiatives. LEVEL OF EVIDENCE Level 5 Laryngoscope, 2023.

International Pediatric Otolaryngology Group (IPOG) consensus recommendations: Evaluation and management of congenital tracheal stenosis
Douglas R. Sidell, Kara D. Meister, Alessandro de Alarcon, An Boudewyns, Matthew Brigger, Robert Chun, Pierre Fayoux, Steven Goudy, Catherine K. Hart, Richard Hewitt, Wei-Chung Hsu, Luv R. Javia, Romaine F. Johnson, Anna H. Messner, Eric Moreddu, Richard Nicollas, Jeremy D. Prager, Reza Rahbar, Scott Rickert, Marie-Eva Rossi, John Russell, Michael Rutter, Kishore Sandu, Richard J.H. Smith, Marlene Soma, Briac Thierry, Marilena Trozzi, David R. White, and Karthik Balakrishnan
International Journal of Pediatric Otorhinolaryngology, ISSN: 01655876, eISSN: 18728464, Volume: 161, Published: October 2022 Elsevier BV

3D bioprinting in airway reconstructive surgery: A pilot study
Miriam Torsello, Antonio Salvati, Luca Borro, Duino Meucci, Maria Luisa Tropiano, Fabrizio Cialente, Aurelio Secinaro, Andrea Del Fattore, Caristo Maria Emiliana, Paola Francalanci, Giulia Battafarano, Ilaria Cacciotti, and Marilena Trozzi
International Journal of Pediatric Otorhinolaryngology, ISSN: 01655876, eISSN: 18728464, Volume: 161, Published: October 2022 Elsevier BV

Pediatric Bilateral Vocal Cord Immobility: New Treatment With Preservation of Voice
Marilena Trozzi, Miriam Torsello, Duino Meucci, Mariella Micardi, Maria L. Tropiano, Sara Balduzzi, Alejandra Ossandon Avetikian, Antonio Salvati, and Sergio Bottero
Laryngoscope, ISSN: 0023852X, eISSN: 15314995, Published: 2022 Wiley
OBJECTIVES Pediatric bilateral vocal cord immobility (BVCI) represents a severe life-threatening condition that often causes severe dyspnea. Endoscopic arytenoid lateral abduction (EALA) is a relatively new, secure, minimal-invasive surgical technique. The present prospective observational study aims to evaluate the effects of EALA in terms of respiratory function, voice quality, and swallowing capabilities. METHODS Twenty-one pediatric patients with BVCI underwent EALA. Eleven out of 21 patients had tracheostomy at the time of surgery. Pre and postoperative functional assessments included endoscopic evaluation, maximum phonation time, pediatric Voice Handicap Index (pVHI), GIRBAS Scale criteria, and Montreal Children's Hospital Feeding scale (MCH-Feeding scale). peak tidal inspiratory flow or peak inspiratory flow (PIF) and number of desaturations/hour (ODI/h) were evaluated in patients without tracheostomy. RESULTS Postoperative endoscopy showed glottic airway improvement in all patients. Average time for decannulation was 4.6 weeks. One patient has not yet been decannulated. No major complications occurred. In patients without tracheostomy, we observed a significant improvement of ODI/h and PIF after surgery (p < 0.05) as expected. PVHI, MCH-Feeding scale, and GIRBAS score significantly worsened 1 month after surgical intervention (p < 0.05). One year after surgery, however, all values, except for B and A parameters of the GIRBAS score, returned to levels comparable to those preoperative. CONCLUSIONS EALA represents a simple, safe and effective solution in pediatric patients with BVCI, avoiding tracheostomy, allowing early decannulation, preserving swallowing function, and maintaining good quality voice. LEVEL OF EVIDENCE 4 Laryngoscope, 2022.

Pediatric Voice Handicap Index (pVHI): A Tool for Evaluating the Reliability and Validity of Voice Therapy in Children With Benign Vocal Fold Nodules
Fabrizio Cialente, Miriam Torsello, Duino Meucci, Maria Luisa Tropiano, Antonio Salvati, and Marilena Trozzi
Journal of Voice, ISSN: 08921997, eISSN: 18734588, Published: 2022 Elsevier BV

Management of Upper Airway Infantile Hemangiomas: Experience of One Italian Multidisciplinary Center
Marialuisa Corbeddu, Duino Meucci, Andrea Diociaiuti, Simona Giancristoforo, Roberta Rotunno, Michaela Veronika Gonfiantini, Marilena Trozzi, Sergio Bottero, and May El Hachem
Frontiers in Pediatrics, eISSN: 22962360, Published: 7 December 2021 Frontiers Media SA
Airway infantile hemangiomas (IHs) can represent a life-threatening condition since the first months of life. They may be isolated or associated to cutaneous IHs, and/or part of PHACES syndrome. Diagnosis, staging, and indication to treatment are not standardized yet despite the presence in the literature of previous case series and reviews. The diagnosis might be misleading, especially in the absence of cutaneous lesions. Airway endoscopy is the gold standard both for diagnosis and follow-up since it allows evaluation of precise localization and entity of obstruction and/or stricture. Proliferation of IH in the infant airways manifests frequently with stridor and treatment is required as soon as possible to prevent further complications. The first line of therapy is oral propranolol, but duration of treatment is not yet well-defined. All considered, we report the experience of our multidisciplinary center from 2009 to date, on 36 patients affected by airway IHs, and successfully treated with oral propranolol. Thus, the authors propose their experience for the management of airway IHs, specifically early diagnosis, when to perform endoscopy, how to interpret its findings, and when to stop the treatment.

Changes in breathing patterns after surgery in severe laryngomalacia
Fabrizio Cialente, Duino Meucci, Maria Luisa Tropiano, Antonio Salvati, Miriam Torsello, Ferdinando Savignoni, Francesca Landolfo, Andrea Dotta, and Marilena Trozzi
Children, eISSN: 22279067, Published: December 2021 MDPI AG
Background: Most of the studies regarding the surgical treatment of severe laryngomalacia (LM) have been aimed at describing the efficacy of the treatment in terms of improvement of clinical symptoms or anatomical findings. There are no studies specifically aimed at analyzing the changes in breathing patterns following surgical treatment for severe LM. Objective: To review the breathing pattern changes before and after corrective surgery in infants with severe LM. Study design: A series of retrospective cases at a tertiary referral children’s hospital. Methods: Retrospective chart review of 81 infants who underwent supra-glottoplasty (SGP) for severe laryngomalacia between 2011 and 2020 at Bambino Gesù Children’s Hospital of Rome, Italy. Among the patients, 47 (58%) were male and 34 (42%) were female. Twenty-one patients (26%) had one or more comorbidities condition. The data collected included age, symptoms, a polysomnography/pulse oximetry study, growth rate, the findings from flexible endoscopy, pre- and post-supra-glottoplasty (SGP) pulmonary function tests (PFTs) and, when indicated, 24 h pH-metry. Breathing patterns were studied during restful, normal sleep, using an ultrasonic flow-meter (Exhalyzer, Viasys) which measured: Tidal Volume (Vt), Respiratory Rate (RR), time to peak expiratory flow/expiratory time ratio (tPTEF/Te, an index of the patency of the lower airways) and mean expiratory/mean inspiratory flow ratio (MEF/MIF, an index of the patency of the upper airways) evaluated before surgical procedure (T1) and 3–6 weeks after (T2). Pre- and post-operative mean data were calculated and comparisons made with a Student T-test. Results: The surgical procedure was well tolerated by all infants and no intraoperative or post-operatory long-term complications were noted. In T1, breathing patterns were characterized by low tidal volume and high tPTEF/Te and MEF/MIF ratios, suggesting a severe reduction in the patency of the upper airways in all patients. After surgery (T2), all the previously mentioned variables significantly improved, reaching normal values for the child’s age. Conclusions: Supra-glottoplasty, as already described in several studies, is a safe and efficient procedure to treat severe laryngomalacia during infancy. The improvement in breathing patterns after surgery was reliably confirmed by a lung function test in our study, which showed the diagnostic value of testing respiratory functionality in the laryngomalacia and comparing them to clinical and endoscopic data. Moreover, considering the results obtained, we also propose the use of this available, dependable test to verify its therapeutic effects (post-surgery) and to monitor future respiratory development in these infants. Moreover, we believe that further studies will provide detailed grading guidelines for gravity of the LM, based on these functional lung tests.

Assessing the effect of adenoidectomy on nasal resistance and airflow. A systematic review and meta-analysis
Christian Calvo-Henriquez, Ana María Branco, Jerome R. Lechien, Vilma Sandoval-Pacheco, Byron Maldonado-Alvarado, Juan Maza-Solano, Marilena Trozzi, Irene Rivero-Fernández, Gabriel Martínez-Capoccioni, and Carlos Martin-Martin
International Journal of Pediatric Otorhinolaryngology, ISSN: 01655876, eISSN: 18728464, Volume: 151, Published: December 2021 Elsevier BV
OBJECTIVE Clinical guidelines suggest adenoidectomy when enlarged adenoids are associated with nasal obstruction and other symptoms. Given that nasal obstruction is the leading symptom of adenoid hypertrophy, it should be thoroughly explored. However, there is no consensus regarding what could be the best approach. This systematic review is designed with the objective of exploring the extent to which adenoidectomy can decrease nasal resistance through rhinomanometry. REVIEW METHODS 3 authors members of the YO-IFOS rhinology study group independently analyzed the data sources (Pubmed, the Cochrane Library, EMBASE, SciELO) for papers assessing the change in nasal resistance and/or nasal airflow in rhinomanometry after adenoidectomy in pediatric patients. RESULTS A total of 9 studies with a total population of 423 participants (323 patients excluding healthy controls) met the inclusion criteria. All of them found decreased nasal resistance after adenoidectomy. 5 studies could be combined in a metanalysis, which revealed a statistically significant difference of 0.52 Pa in basal conditions, and 0.64 Pa in rhinomanometry under nasal decongestion. 4 authors explored changes in nasal airflow. All of them found a statistically significant increase in nasal airflow after adenoidectomy. However, their results could not be merged in a meta-analysis. CONCLUSION This systematic review and meta-analysis demonstrated the existence of a systematic decrease in nasal resistance and increase in nasal airflow with and without nasal decongestant after adenoidectomy. The available evidence suggests that rhinomanometry with nasal decongestant could help in intermediate cases of adenoid hypertrophy, in order to identify the presence of nasal obstruction and, when present, the possibility of other causes for it rather than enlarged adenoids, mainly turbinate hypertrophy.

Endoscopic arytenoid lateroabduction (EALA) in the treatment of bilateral vocal cord palsy
M. Trozzi, D. Meucci, and A. Salvati
European Annals of Otorhinolaryngology, Head and Neck Diseases, ISSN: 18797296, Volume: 138, Pages: 12-13, Published: August 2021 Elsevier BV

The Role of Lung Function Testing in Newborn Infants With Congenital Thoracic Arterial Anomalies
Claudia Columbo, Francesca Landolfo, Domenico Umberto De Rose, Anna Claudia Massolo, Aurelio Secinaro, Teresa Pia Santangelo, Marilena Trozzi, Cosimo Marco Campanale, Alessandra Toscano, Irma Capolupo, Pietro Bagolan, and Andrea Dotta
Frontiers in Pediatrics, eISSN: 22962360, Published: 15 June 2021 Frontiers Media SA
Introduction: Congenital thoracic arterial anomalies (CTAAs), such as complete or incomplete vascular rings, pulmonary artery sling, and innominate artery compression syndrome, may cause severe tracheomalacia and upper airway obstruction. An obstructive ventilatory pattern at lung function testing (LFT) has been suggested in the presence of CTAA. The severity of obstruction may be evaluated by LFT. Little is known about the use of LFT in newborn infants with CTAA. The aim of our study is to evaluate the role of LFT in CTAA diagnosis.Methods: This is a retrospective study, conducted between February 2016 and July 2020. All CTAA cases for whom LFT was performed preoperatively were considered for inclusion. Tidal volume (Vt), respiratory rate, and the ratio of time to reach the peak tidal expiratory flow over total expiratory time (tPTEF/tE) were assessed and compared to existing normative data. Demographics and CTAA characteristics were also collected.Results: Thirty cases were included. All infants with CTAA showed a significantly reduced Vt and tPTEF/tE, compared to existing normative data suggesting an obstructive pattern.No significant differences were found for LFT between cases with a tracheal obstruction &lt;50% compared to those with tracheal obstruction ≥50%, or between cases with and without symptoms. Sixteen infants (53.3%) had respiratory symptoms related to CTAA. Of these, only two cases had also dysphagia.Conclusion: LFT values were significantly reduced in cases with CTAA before surgery. LFT represents a potential feasible and non-invasive useful tool to guide diagnosis in the suspect of CTAA.

International Pediatric Otolaryngology Group (IPOG) management recommendations: Pediatric tracheostomy decannulation
Aimee Kennedy, Catherine K. Hart, Alessandro de Alarcon, Karthik Balakrishnan, An Boudewyns, Robert Chun, Pierre Fayoux, Steven L. Goudy, Christopher Hartnick, Wei-Chung Hsu, Romaine F. Johnson, Michael Kuo, Shazia Peer, Seth M. Pransky, Reza Rahbar, Scott Rickert, Soham Roy, John Russell, Kishore Sandu, Douglas R. Sidell, Richard J. Smith, Marlene Soma, Jorge Spratley, Briac Thierry, Dana M. Thompson, Marilena Trozzi, Karen Watters, David R. White, Michelle Wyatt, George H. Zalzal, Carlton J. Zdanksi, Karen B. Zur, and Michael J. Rutter
International Journal of Pediatric Otorhinolaryngology, ISSN: 01655876, eISSN: 18728464, Volume: 141, Published: February 2021 Elsevier BV
OBJECTIVES To provide recommendations to otolaryngologists, pulmonologists, and allied clinicians for tracheostomy decannulation in pediatric patients. METHODS An iterative questionnaire was used to establish expert recommendations by the members of the International Pediatric Otolaryngology Group. RESULTS Twenty-six members completed the survey. Recommendations address patient criteria for decannulation readiness, airway evaluation prior to decannulation, decannulation protocol, and follow-up after both successful and failed decannulation. CONCLUSION Tracheostomy decannulation recommendations are aimed at improving patient-centered care, quality and safety in children with tracheostomies.

Surgical Options for Pediatric Bilateral Vocal Cord Palsy: State of the Art
Marilena Trozzi, Duino Meucci, Antonio Salvati, Maria Luisa Tropiano, and Sergio Bottero
Frontiers in Pediatrics, eISSN: 22962360, Published: 9 December 2020 Frontiers Media SA
Management of pediatric bilateral vocal cord palsy (BVCP) is a controversial and challenging topic. It may represent a severe obstructive condition usually associated with respiratory distress, and, in such condition, tracheostomy has been considered the gold standard for a long time. Many surgical options have been described and used to increase the glottic space in BVCP (1), with ongoing research of less invasive techniques. The challenge and current trend in our department and in many major pediatric centers is to avoid tracheotomy through an early treatment. Many techniques introduced in the last decade reduced the number of tracheotomies and increased the decannulation rate. Furthermore, we observed a recent increase in attention to preserve the quality of the voice with new techniques, such as endoscopic arytenoid abduction lateropexy which is in our opinion an important innovation to improve glottic space with satisfactory voice results. We present a review of the literature about the evolution of the treatment options for pediatric BVCP during the years.

International Pediatric Otolaryngology Group (IPOG): Consensus recommendations on the prenatal and perinatal management of anticipated airway obstruction
Michael D. Puricelli, Reza Rahbar, Gregory C. Allen, Karthik Balakrishnan, Matthew T. Brigger, Sam J. Daniel, Pierre Fayoux, Steven Goudy, Richard Hewitt, Wei-Chung Hsu, Jonathan B. Ida, Romaine Johnson, Nicolas Leboulanger, Scott M. Rickert, Soham Roy, John Russell, Michael Rutter, Douglas Sidell, Marlene Soma, Briac Thierry, Marilena Trozzi, George Zalzal, Carlton J. Zdanski, and Richard J.H. Smith
International Journal of Pediatric Otorhinolaryngology, ISSN: 01655876, eISSN: 18728464, Volume: 138, Published: November 2020 Elsevier BV
OBJECTIVE To make recommendations on the identification, routine evaluation, and management of fetuses at risk for airway compromise at delivery. METHODS Recommendations are based on expert opinion by members of the International Pediatric Otolaryngology Group (IPOG). A two-iterative Delphi method questionnaire was distributed to all members of the IPOG and responses recorded. The respondents were given the opportunity to comment on the content and format of the survey, which was modified for the second round. "Consensus" was defined by >80% respondent affirmative responses, "agreement" by 51-80% affirmative responses, and "no agreement" by 50% or less affirmative responses. RESULTS Recommendations are provided regarding etiologies of perinatal airway obstruction, imaging evaluation, adjunct evaluation, multidisciplinary team and decision factors, micrognathia management, congenital high airway obstruction syndrome management, head and neck mass management, attended delivery procedure, and delivery on placental support procedure. CONCLUSIONS Thorough evaluation and thoughtful decision making are required to optimally balance fetal and maternal risks/benefits.

International registry of otolaryngologist–head and neck surgeons with COVID-19
Leigh J Sowerby, Kate Stephenson, Alexander Dickie, Federico A. Di Lella, Niall Jefferson, Hannah North, R. Daniele De Siati, Rebecca Maunsell, Michael Herzog, Raghu Nandhan, Marilena Trozzi, Puya Dehgani‐Mobaraki, Antoine Melkane, Claudio Callejas, Harald Miljeteig, Diane Smit, Daniel Dibildox Reynoso, Joao Eloi Moura, Ann Hermansson, Shazia Peer, Lisa Burnell, Nicolas Fakhry, Carlos Chiesa‐Estomba, Özlem Önerci Çelebi, Sergei Karpischenko, Steven Sobol, Zoukaa Sargi, and Zara M. Patel
International Forum of Allergy and Rhinology, ISSN: 20426976, eISSN: 20426984, Pages: 1201-1208, Published: 1 November 2020 Wiley
It has become clear that healthcare workers are at high risk, and otolaryngology has been theorized to be among the highest risk specialties for coronavirus disease 2019 (COVID‐19). The purpose of this study was to detail the international impact of COVID‐19 among otolaryngologists, and to identify instructional cases.

Reflux and dental disorders in the pediatric population: A systematic review
Jerome R. Lechien, Christian CALVO-HENRIQUEZ, Carlos M. Chiesa-Estomba, Maria Rosaria Barillari, Marilena Trozzi, Duino Meucci, Shazia Peer, Fairouz Ben Abdelouahed, Antonio Schindler, and Sven Saussez
International Journal of Pediatric Otorhinolaryngology, ISSN: 01655876, eISSN: 18728464, Volume: 136, Published: September 2020 Elsevier BV
OBJECTIVES To investigate the role of laryngopharyngeal reflux (LPR) or gastroesophageal reflux disease (GERD) in the development of dental disorders in pediatric population. METHODS PubMed, Scopus Cochrane database were assessed for subject headings using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) recommendations. Relevant studies published between January 1990 and January 2020 describing the association between reflux and dental disorders in children were retrieved. Three authors reviewed the LPR diagnosis method; inclusion criteria and outcomes. The bias analysis was performed through the tools of the Oxford Centre for Evidence-Based Medicine evidence levels. RESULTS The electronic search identified 126 publications, of which 11 clinical studies and 2 basic science researches met our inclusion criteria. There is an important heterogeneity between studies about diagnostic method and clinical outcome evaluation. All studies based the reflux diagnosis on GERD criteria. No author considered hypopharyngeal nonacid reflux episodes through hypopharyngeal-esophageal intraluminal multichannel impedance pH monitoring (HEMII-pH). The results of studies support a higher prevalence of dental erosion in children with GERD compared with healthy individuals. Controversial findings were found about the potential association between reflux and caries, and the modification of both saliva composition and production in reflux children. CONCLUSION The association between reflux and dental disorder is still uncertain. Future studies considering pharyngeal acid and nonacid reflux episodes through HEMII-pH are needed to confirm this hypothesis. The pepsin detection in saliva would be an additional way for detecting LPR in children with dental disorders.

International Pediatric Otolaryngology Group (IPOG): Juvenile-onset recurrent respiratory papillomatosis consensus recommendations
Claire Lawlor, Karthik Balakrishnan, Sergio Bottero, An Boudewyns, Paolo Campisi, John Carter, Alan Cheng, Alejandro Cocciaglia, Alessandro DeAlarcon, Craig Derkay, Pierre Fayoux, Catherine Hart, Christopher Hartnick, Nicolas LeBoulanger, Eric Moreddu, Harlan Muntz, Richard Nicollas, Shazia Peer, Seth Pransky, Reza Rahbar, John Russell, Michael Rutter, Riaz Seedat, Douglas Sidell, Richard Smith, Marlene Soma, Julie Strychowsky, Dana Thompson, Jean-Michel Triglia, Marilena Trozzi, Michelle Wyatt, George Zalzal, Karen B. Zur, and Roger Nuss
International Journal of Pediatric Otorhinolaryngology, ISSN: 01655876, eISSN: 18728464, Volume: 128, Published: January 2020 Elsevier BV
OBJECTIVES To develop consensus recommendations for the evaluation and management of juvenile-onset recurrent respiratory papillomatosis (JORRP) in pediatric patients. METHODS Expert opinion by the members of the International Pediatric Otolaryngology Group (IPOG). The mission of the IPOG is to develop expertise-based consensus recommendations for the management of pediatric otolaryngologic disorders with the goal of improving patient care. The consensus recommendations herein represent the first publication by the group. RESULTS Consensus recommendations including diagnostic considerations, surgical management, systemic adjuvant therapies, postoperative management, surveillance, and voice evaluation. These recommendations are based on the collective opinion of the IPOG members and are targeted for otolaryngologists, primary care providers, pulmonologists, infectious disease specialists, and any other health care providers that manage patients with JORRP. CONCLUSIONS Pediatric JORRP consensus recommendations are aimed at improving care and outcomes in this patient population.

Use OF NBI for the assessment of clinical signs of rhino-pharyngo-laryngeal reflux in pediatric age: Preliminary results
J. Galli, D. Meucci, G. Salonna, R. Anzivino, V. Giorgio, M. Trozzi, S. Settimi, M.L. Tropiano, G. Paludetti, and S. Bottero
International Journal of Pediatric Otorhinolaryngology, ISSN: 01655876, eISSN: 18728464, Volume: 128, Published: January 2020 Elsevier BV
OBJECTIVES Laryngopharyngeal reflux (LPR) is a complex problem in pediatric population: diagnosis and clinical presentation are still controversial. Classic white light endoscopy shows some pathognomonic signs of LPR in children, such as thickening of pharyngo-laryngeal mucus, the cobblestoning aspect of pharyngeal mucosa, arytenoid edema/hyperemia, nodular thickening/true vocal cord edema, hypertrophy of the posterior commissure, subglottic edema. The NBI (Narrow Band Imaging) technology, generally used in oncology, allows to study neoangiogenesis and hypervascularization of the mucosa, common aspects in both chronic inflammation and neoplastic transformation. The aim of our study was to evaluate the added value of this technology in identifying the main laryngopharyngeal reflux sign in a pediatric population. METHODS We evaluated at the Otolaryngology Unit of the "Fondazione Policlinico A. Gemelli" hospital and the Airway Surgery Unit of the "Bambino Gesù" Children's Hospital 35 patients aged from 2 months to 16 years divided into two groups in the period between November 2017 and May 2018. Group A included patients with clinical suspicion of LPR after gastroenterologist evaluation and Group B included patients who underwent an endoscopic evaluation for the assessment of recurrent respiratory symptoms such as stridor, recurrent croup, wheezing and persistent cough. We performed an endoscopic evaluation by white light and NBI for each patient, comparing the results of both methods to evaluate signs of pharyngo-laryngeal reflux and to calculate the value of reflux finding score (RFS). RESULTS The analysis of the data showed: for Group A an average value of RFS with white light of 11,84 (range 8-17, standard deviation 2,52 ± 0,57) and with NBI of 13,63 (range 10-17, standard deviation 2,13 ± 0,49); for Group B the analysis of the data showed an average value of RFS with white light of 10,06 (range 8-14, standard deviation 2,32 ± 0,58) and with NBI of 12,50 (range 9-18, standard deviation 2,63 ± 0,65). The comparison between the two methods resulted significant. Furthermore evaluation by NBI allowed to highlight other signs of pharyngo-laryngeal reflux, characteristic of pediatric age and not included in RFS, in particular cobblestone aspect of the hypopharingeal mucosa, phlogosis of the tonsillar crypts and adenoid surface, hyperemia and hypervascularization of subglottic and tracheal mucosa. CONCLUSION Although still preliminary our results represent an interesting starting point for further studies, because they underline the potentiality of NBI endoscopy in LPR evaluation and how this technology could improve the identification of reflux signs.

International Pediatric Otolaryngology Group (IPOG) consensus recommendations: Diagnosis, pre-operative, operative and post-operative pediatric choanal atresia care
Eric Moreddu, Mark Rizzi, Eelam Adil, Karthik Balakrishnan, Kenny Chan, Alan Cheng, Sam J. Daniel, Alessandro de Alarcon, Catherine Hart, Christopher Hartnick, Andrew Inglis, Nicolas Leboulanger, Seth Pransky, Reza Rahbar, John Russell, Mike Rutter, Douglas Sidell, Richard J.H. Smith, Marlene Soma, Jorge Spratley, Dana Thompson, Marilena Trozzi, Robert Ward, Michelle Wyatt, Jeffrey Yeung, George Zalzal, Karen Zur, and Richard Nicollas
International Journal of Pediatric Otorhinolaryngology, ISSN: 01655876, eISSN: 18728464, Volume: 123, Pages: 151-155, Published: August 2019 Elsevier BV
OBJECTIVE To provide recommendations to otolaryngologists and allied physicians for the comprehensive management of young infants who present with signs or symptoms of choanal atresia. METHODS A two-iterative delphi method questionnaire was used to establish expert recommendations by the members of the International Otolaryngology Group (IPOG), on the diagnostic, intra-operative, post-operative and revision surgery considerations. RESULTS Twenty-eight members completed the survey, in 22 tertiary-care center departments representing 8 countries. The main consensual recommendations were: nasal endoscopy or fiberscopy and CT imaging are recommended for diagnosis; unilateral choanal atresia repair should be delayed after at least age 6 months whenever possible; transnasal endoscopic repair is the preferred technique; long term follow-up is recommended (minimum one year) using nasal nasofiberscopy or rigid endoscopy, without systematic imaging. CONCLUSION Choanal atresia care consensus recommendations are aimed at improving patient-centered care in neonates, infants and children with choanal atresia.

Vocal cord paralysis appears to be an acquired lesion in children with repaired esophageal atresia/tracheoesophageal fistula
Thomas Kovesi, Federica Porcaro, Francesca Petreschi, Marilena Trozzi, Sergio Bottero, and Renato Cutrera
International Journal of Pediatric Otorhinolaryngology, ISSN: 01655876, eISSN: 18728464, Volume: 112, Pages: 45-47, Published: September 2018 Elsevier BV
OBJECTIVES Determine whether vocal cord paresis or paralysis (VCP/P) following surgical repair of congenital esophageal atresia/tracheoesophageal fistula (EA/TEF) is generally a primary anomaly, or is secondary to EA/TEF repair. METHODS We carried out a retrospective study based on a recently published protocol, which included the systematic performance of a laryngo-tracheo-bronchoscopy before and after EA/TEF repair. RESULTS There were 105 patients with EA/TEF referred for multidisciplinary follow-up, between 2010 and 2015. Sixty-four of the 105 patients included in the study underwent EA/TEF repair at the referral center and had pre-operative bronchoscopy; the others had their initial surgery elsewhere. No included patient had VCP/P detected pre-operatively. Six patients (4 initially managed at the referral center) were diagnosed with VCP/P during the follow-up period (6/105, 5.7%). CONCLUSION VCP appears to be an acquired lesion in this population.

Dehiscence of Bronchial Anastomosis After Lung Transplantation: A Successful Unconventional Treatment
Sergio Bottero, Duino Meucci, Marilena Trozzi, and Adriano Carotti
Annals of Thoracic Surgery, ISSN: 00034975, eISSN: 15526259, Volume: 106, Pages: e81-e83, Published: August 2018 Elsevier BV
Anastomotic airway complications, including the dehiscence of the bronchial anastomosis, are a severe cause of morbidity after lung transplantation. We present a case of dehiscence treated by placing an uncovered metal stent into the main bronchus. We usually use this procedure for bronchial stenosis, but in this case, the stent favored the growth of granulation tissue and so the closure of the dehiscence. This procedure was minimally invasive and may be an alternative to an open repair, without precluding open repair in case of failure.

Emerging and re-emerging infectious disease in otorhinolaryngology
F. Scasso, G. Ferrari, G. D. De Vincentiis, A. Arosio, S. Bottero, M. Carretti, A. Ciardo, S. Cocuzza, A. Colombo, B. Conti, A. Cordone, M. DE Ciccio, E. Delehaye, L. Della Vecchia, I. De Macina, C. Dentone, P. Di Mauro, R. Dorati, R. Fazio, A. Ferrari, G. Ferrea, S. Giannantonio, I. Genta, M. Giuliani, D. Lucidi, L. Maiolino, G. Marini, P. Marsella, D. Meucci, T. Modena, B. Montemurri, A. Odone, S. Palma, M. Panatta, M. Piemonte, P. Pisani, S. Pisani, L. Prioglio, A. Scorpecci, L. Scotto di Santillo, A. Serra, C. Signorelli, E. Sitzia, M. Tropiano, M. Trozzi, F. M. Tucci, L. Vezzosi and B. Viaggi
Acta Otorhinolaryngologica Italica, ISSN: 0392100X, eISSN: 1827675X, Pages: S1-S106, Published: April 2018
SUMMARY Emerging and re-emerging infectious disease in otorhinolaryngology (ENT) are an area of growing epidemiological and clinical interest. The aim of this section is to comprehensively report on the epidemiology of key infectious disease in otorhinolaryngology, reporting on their burden at the national and international level, expanding of the need of promoting and implementing preventive interventions, and the rationale of applying evidence-based, effective and cost- effective diagnostic, curative and preventive approaches. In particular, we focus on i) ENT viral infections (HIV, Epstein-Barr virus, Human Papilloma virus), retrieving the available evidence on their oncogenic potential; ii) typical and atypical mycobacteria infections; iii) non-specific granulomatous lymphadenopathy; iv) emerging paediatric ENT infectious diseases and the prevention of their complications; v) the growing burden of antimicrobial resistance in ENT and the strategies for its control in different clinical settings. We conclude by outlining knowledge gaps and action needed in ENT infectious diseases research and clinical practice and we make references to economic analysis in the field of ENT infectious diseases prevention and care.

Bronchial Mismatch as a Predictor of Respiratory Failure After Congenital Tracheal Stenosis Repair
Enrico Cetrano, Matteo Trezzi, Aurelio Secinaro, Luca Di Chiara, Marilena Trozzi, Sergio Bottero, Angelo Polito, and Adriano Carotti
Annals of Thoracic Surgery, ISSN: 00034975, eISSN: 15526259, Volume: 105, Pages: 1264-1271, Published: April 2018 Elsevier BV
BACKGROUND The purpose of this study was to identify predictors of postoperative respiratory failure after surgical tracheoplasty for congenital tracheal stenosis. METHODS Between February 2011 and April 2017, 16 infants underwent congenital tracheal stenosis repair. Preoperative computed tomography evaluation of the trachea and mainstem bronchi was performed. The primary outcome was midterm freedom from postoperative respiratory failure defined as persistent need for mechanical ventilation or surgical tracheobronchial reoperation. Bronchial mismatch, defined as [1 - (smaller bronchus diameter / larger bronchus diameter)] × 100, was analyzed in relation to the primary outcome. RESULTS Median age was 106 days (range, 1 to 406) and median weight was 5.3 kg (range, 2.6 to 8 kg). Four patients were neonates (25%) and 6 had genetic abnormalities (37.5%). There were no early nor late deaths. Median ventilation time was 5.5 days (range, 3 to 45). Mean follow-up time was 2.2 years (range, 0.1 to 4.5). Four patients with bronchial mismatch greater than 20% had postoperative respiratory failure (p = 0.002). Two of them underwent tracheostomy and were discharged with ventilation home care support. One underwent successful reoperation consisting of bilateral bronchial plasty with autologous cartilage rib grafts, and the other underwent successful right bronchial and tracheal reconstruction. One patient with bilateral bronchial hypoplasia underwent slide tracheoplasty associated with preemptive bilateral bronchial plasty and made a full recovery. CONCLUSIONS Surgical treatment of congenital tracheal stenosis in neonates and infants portends a good outcome. Bronchial mismatch greater than 20% can identify a subset of patients at increased risk for surgical reintervention and chronic respiratory failure. Slide tracheoplasty with preemptive bronchial reconstruction may prevent postoperative respiratory failure.

Laryngotracheal abnormalities in esophageal atresia patients: A hidden entity
Andrea Conforti, Laura Valfrè, Marianna Scuglia, Marilena Trozzi, Duino Meucci, Stefania Sgrò, Sergio Bottero, and Pietro Bagolan
Frontiers in Pediatrics, eISSN: 22962360, Published: 2018 Frontiers Media SA
Importance: Presence of laryngotracheal abnormalities is associated with increased morbidity and higher mortality rate in esophageal atresia patients. Objective: Determine the prevalence of laryngotracheal abnormalities (LTA) in a prospectively collected cohort of patients treated for esophageal atresia and/or tracheoesophageal fistula (EA/TEF). Analysis of the impact of those airway anomalies in early post-operative outcomes was performed. Patients and Methods: This was a review of a prospectively collected database, including patients from January 2008 to December 2017. Patients enrolled in the present study were treated in a high-volume referral center. Present study included all newborn-infants consecutively treated for EA/TEF. All patients were evaluated by flexible laryngotracheoscopy performed under local anesthesia in spontaneous breathing. In case of airway malformation suspected during flexible endoscopy, a rigid endoscopy was performed to complete airway assessment. If post-operative respiratory symptoms (noisy breathing, respiratory difficulty, failure to extubate, or difficulty feeding) were noted, a second laryngotracheoscopy was performed. Primary study outcome was to evaluate the prevalence of LTA in EA/TEF infants, characterizing of LTA, and their impact on early post-operative outcomes. Those primary study outcomes were planned before data collection began. Results: During the study period 207 patients with EA/TEF were treated. LTA had a period prevalence of 40.1% (83/207). Although no differences were recorded in terms of demographics and clinical presentation, LTA+ infants more frequently required tracheostomy (12/52, 23% vs. 0/124, 0%; p 0.0001) and were at increased risk of death (12/83, 14% vs. 5/124, 4%; p 0.009) in comparison with EA/TEF without LTA. Conclusions: Present data suggest a high prevalence of congenital LTA in patients affected by EA. Most of the abnormalities are congenital and a high proportion of patients with LTA require a tracheostomy. Mortality significantly correlates with the presence of LTA. Systematic airway endoscopic preoperative evaluation has to be pushed forward to minimize LTA-related morbidity and mortality.

Cervical repair of congenital tracheoesophageal fistula: Complications lurking!
Andrea Conforti, Chiara Iacusso, Laura Valfrè, Marilena Trozzi, Sergio Bottero, and Pietro Bagolan
Journal of Pediatric Surgery, ISSN: 00223468, eISSN: 15315037, Pages: 1623-1626, Published: 1 October 2016 Elsevier BV
AIM Esophageal atresia (EA) and tracheoesophageal fistula (TEF) consist of a spectrum of rare congenital abnormalities. Although EA surgical treatment is well established, the outcome of EA with proximal fistula (type B and D EA) or isolated H-type fistula (type E EA) is poorly explored. These forms of EA shared a common surgical step: the need of a cervical approach to close the fistula. Therefore, the aim of present study is to evaluate postoperative outcomes of patients treated for Gross type B-D and E EA, on regards of their cervical surgery. MATERIALS AND METHODS A retrospective case series analysis of all patients affected by type B-D and E EA, and admitted to our tertiary care center between January 2003 and December 2014 was performed. All patients underwent preoperative flexible laryngo-tracheobronchoscopy (LTBS) as part of our standardized preoperative diagnostic assessment to define the diagnosis, evaluate preoperative vocal cord motility and to cannulate the fistula when required. Fistula closure was always performed through a right cervical access. Analysis of all cases and comparison between type B-D and E EA were performed. Mann-Whitney test, Chi-squared test and unpaired t test were used as appropriate; p<0.05 was considered significant. RESULTS During the study period, 180 EA newborns were treated. Proximal or isolated TEF was found in 18 patients (10%): 7 type B, 11 type E EA. Patients affected by type B and E EA/TEF frequently present associated major malformations (27%), and major cardiac abnormalities (44%). Major postoperative complications were: vocal cord paralysis (5 patients), bilateral in 2 infants requiring tracheostomy, cerebral ischemia (1 patient), and cardiac failure (1 patient). CONCLUSION Patients affected by type B and E EA have a high rate of associated abnormalities, and risk of possible sequelae. Postoperative complications are common, with possible transient vocal cord dismotility, but in some cases persistent paralysis may require tracheostomy. Therefore, both preoperative and postoperative LTBS is highly recommended to evaluate the presence of a proximal fistula, and vocal cord motility, even in asymptomatic patients, to rule out any possible intraoperative "surprise" and any vocal cord abnormality and to possibly define its pathogenesis (congenital vs. iatrogenic).

Injuries due to foreign body aspirations in Georgia: A prevention perspective
Paata Gvetadze, Ivane Chkhaidze, Solidea Baldas, Rosanna Comoretto, and Dario Gregori
International Journal of Pediatric Otorhinolaryngology, ISSN: 01655876, eISSN: 18728464, Pages: 84-87, Published: April 01, 2016 Elsevier BV
BACKGROUND Suffocation due to foreign bodies (FB) is a leading cause of death in children aged 0-3. No data from the former U.S.S.R. are available in the international scientific literature. METHODS Consecutive patients admitted at the Iashvili Central Children Hospital in Tbilisi, Georgia from 1989 to 2011 were analyzed. Injuries in the upper airways due to foreign bodies' inhalation were collected and compared with the Susy Safe Registry and the pooled estimates of the meta-analysis. RESULTS 2896 cases were collected. Distribution of injuries in children younger than 3 years was significantly higher than in the Susy Safe Registry and in the "High-Income" countries in the meta-analysis. Percentage of injuries due to organic objects (86%) was significantly higher than in published data. CONCLUSIONS Since Georgia is not showing any substantial difference, both in epidemiology and treatment of foreign bodies injuries, as compared to the other case series, translation of public health initiatives from other most advanced prevention experiences is possible and it is likely to be effective. LEVEL OF EVIDENCE Level V, Epidemiological case series.

TROZZI MARILENA

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Scopus Publications

TROZZI MARILENA

EDUCATION

RESEARCH INTERESTS

FUTURE PROJECTS

3D Bioprinting in Airway Surgery

Scopus Publications