Airway Surgery Unit, Department of Pediatric Surgery
Bambino Gesù Children's Hospital, Rome Italy

2013- current Consultant Airway Surgery Unity Children’s Hospital Bambino Gesù, Rome

2019- current Lead of Minimal Invasive Reconstructive Neonatal Airway Surgery Children’s Hospital Bambino Gesù, Rome

2017- current Italian Delegate, IPOG (International Pediatric Otolaryngology Group)
Italian Delegate, Research Committee at YO-IFOS (Young Otolaryngologist- International Federation Otolaryngology Societies)

2016 - current International Member of American Society Pediatric Otolaryngology

2012 - 2013 Fellow Great Ormond Street Hospital, London

2006 – 2012 Consultant/Clinical Researcher Children’s Hospital Bambino Gesù, Rome

2004 – 2005 Clinical Researcher Regina Elena National Cancer Institute of Rome


2004-2007 PhD in Neck Pathology: Recurrent Respiratory Papillomatosis. La Sapienza, University of Rome

2005-2006 UNIVERSITY DIPLOMA (DU) in Microsurgery. (Chief: , Paris 7 University Denis Diderot

2003-2004 RESIDENT-Department of Head and Neck Surgery, (Chief: B. Luboinski), Institut Gustave Roussy

2000-2004 Board Certification Otorinolaryngology, Department of Otorhinolaryngology, La Sapienza, University of Rome
GPA: 70/70 with honors

1994-2000 MD, University La Sapienza, Rome, Italy


Marilena Trozzi currently works at the Airway Surgery Unit, Bambino Gesù Children's Hospital of Rome. Marilena does research in Pediatric Airway Surgery and Reconstruction. She is Responsible for Minimal Invasive Reconstructive Surgery. She completed her Pediatric ENT Fellowship in 2013 at Great Ormond Street Children's hospital in London. She is part of the IPOG (International Pediatric Otorhinolaringoiatry Group). She is member of ASPO (American Society of Pediatric Otorhinolaringology) and Italian Delegate for Research Committee at YO-IFOS (Young Otorhinolaringology of International Federation ORL Societies)


3D Bioprinting in Airway Surgery

Pre clinical in vivo study on animal model (ovine) to assess the biocompatibility, integration and tolerance of 3D printing in Policaprolacton graft in laryngotracheal reconstruction.

Applications Invited
Ministerial approval

Scopus Publications

Scopus Publications

  • Foreign body aspiration in children: our pediatric tertiary care experience
    Miriam Torsello, Luana Sicuranza, Duino Meucci, Antonio Salvati, Maria Luisa Tropiano, Sara Santarsiero, Cinzia Calabrese, Alessandra D’Onghia, and Marilena Trozzi

    Springer Science and Business Media LLC

  • 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,et al.

    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.

  • 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

    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.

  • Vocal Cord Paralysis and Feeding Difficulties as Early Diagnostic Clues of Congenital Myasthenic Syndrome with Neonatal Onset: A Case Report and Review of Literature
    Domenico Umberto De Rose, Sara Ronci, Stefano Caoci, Chiara Maddaloni, Daria Diodato, Michela Catteruccia, Fabiana Fattori, Luca Bosco, Stefano Pro, Immacolata Savarese,et al.

    Herein, we present a newborn female with congenital vocal cord paralysis who required a tracheostomy in the neonatal period. She also presented with feeding difficulties. She was later diagnosed with a clinical picture of congenital myasthenia, associated with three variants of the MUSK gene: the 27-month follow-up was described. In particular, the c.565C&gt;T variant is novel and has never been described in the literature; it causes the insertion of a premature stop codon (p.Arg189Ter) likely leading to a consequent formation of a truncated nonfunctioning protein. We also systematically collected and summarized information on patients’ characteristics of previous cases of congenital myasthenia with neonatal onset reported in the literature to date, and we compared them to our case. The literature reported 155 neonatal cases before our case, from 1980 to March 2022. Of 156 neonates with CMS, nine (5.8%) had vocal cord paralysis, whereas 111 (71.2%) had feeding difficulties. Ocular features were evident in 99 infants (63.5%), whereas facial-bulbar symptoms were found in 115 infants (73.7%). In one hundred sixteen infants (74.4%), limbs were involved. Respiratory problems were displayed by 97 infants (62.2%). The combination of congenital stridor, particularly in the presence of an apparently idiopathic bilateral vocal cord paralysis, and poor coordination between sucking and swallowing may indicate an underlying congenital myasthenic syndrome (CMS). Therefore, we suggest testing infants with vocal cord paralysis and feeding difficulties for MUSK and related genes to avoid a late diagnosis of CMS and improve outcomes.

  • Pediatric airway compression in aortic arch malformations: a multidisciplinary approach
    Francesca Petreschi, Antonella Coretti, Federica Porcaro, Alessandra Toscano, Cosimo Marco Campanale, Marilena Trozzi, Aurelio Secinaro, Annalisa Allegorico, Renato Cutrera, and Adriano Carotti

    Frontiers Media SA
    BackgroundAortic arch malformations (AAMs) should be suspected in the presence of persistent respiratory symptoms despite medical treatment or feeding problems at the pediatric age.AimWe report a descriptive cohort of patients with AAMs and the local management protocol applied.MethodsA total of 59 patients with AAM were retrospectively reviewed. Three groups were identified: double aortic arch (DAA), group 1; complete vascular ring (non-DAA), group 2; and anomalous origin of the innominate artery (IA), group 3.ResultsPrenatal diagnosis was available for 62.7% of the patients. In all, 49.2% of children were symptomatic. There was a significantly different prevalence of respiratory symptoms within the three groups: 73.7% in group 1, 24.2% in group 2, and 100% in group 3 (p-value: &amp;lt;0.001). Surgery was considered in the presence of symptoms in patients with DAA and in those with reduction of the tracheal section area greater than 50%. A total of 52.5% of the patients underwent surgical repair (median age 6 months). The median follow-up interval was 21.9 months. Respiratory symptoms improved in most symptomatic patients.ConclusionsNo specific protocols are available for the management of patients with AAMs. Conservative treatment seems to be reasonable for asymptomatic patients or those with airway stenosis less than 50%. A close follow-up is necessary to identify early patients who become symptomatic.

  • 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,et al.

    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,et al.

    Elsevier BV

  • 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

    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 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

    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

    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.

  • 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,et al.

    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 &amp;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,et al.

    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 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,et al.

    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,et al.

    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

    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,et al.

    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

    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,et al.

    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

    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

    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,et al.

    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

    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.