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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: JM.Servant), 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

  • 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 <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.

  • Symptoms associated with button batteries injuries in children: An epidemiological review
    Elisa Buttazzoni, Dario Gregori, Bibiana Paoli, Nicola Soriani, Solidea Baldas, Hugo Rodriguez, and Giulia Lorenzoni

    International Journal of Pediatric Otorhinolaryngology, ISSN: 01655876, eISSN: 18728464, Pages: 2200-2207, Published: 1 December 2015 Elsevier BV
    OBJECTIVES To provide an epidemiological framework of symptoms related to Foreign Body (FB) injuries due to Button Battery (BB). METHODS Data on BB ingestion/inhalation have been obtained from the ButtonBatteryDB. The ButtonBatteryDB is a database collecting information on BB injuries in children (0-18 years of age). Data on 348 BB injures have been derived from the Registry of Foreign Body Injuries "Susy Safe" (269 cases) and from published scientific literature reporting case reports of FB injuries (79 cases). RESULTS Most of injured children were male and BBs were found more often in the mouth/esophagus/stomach (ICD935) and in the nose (ICD932). Analyzing symptoms related to BB located in the esophagus/mouth/stomach, we found that children had higher probability of experiencing dysphagia (30.19%, 95% C.I. 17.83-42.55), fever and cough (26.42%, 95% C.I. 14.55-38.28), compared to the other symptoms. Referring to the probability that symptoms occurred simultaneously, fever and cough are more likely (3.72%, 95% C.I. 1.0-6-43) to jointly showing up in children with BB in mouth/esophagus/stomach (ICD935), followed by fever and dysphagia (2.66%, 95% C.I. 0.36-4.96) and by fever and irritability/crying, fever and drooling, dysphagia and irritability/crying (2.13% C.I. 0.00-4.19, 95% C.I.) CONCLUSIONS These findings provide new insight in clinical presentation of BB injuries: the identification of unique patterns of symptoms related to BB injuries is useful to perform an early diagnosis (and to guarantee a prompt medical reaction), also when the injury is un-witnessed.

  • Cochlear re-implant rates in children: 20 years experience in a quaternary paediatric cochlear implant centre
    Marilena Trozzi, Harry R. F. Powell, Shamim Toma, Waseem Ahmed, Christopher G. Jephson, Kaukab Rajput, and Lesley A. Cochrane

    European Archives of Oto-Rhino-Laryngology, ISSN: 09374477, eISSN: 14344726, Volume: 272, Pages: 2667-2672, Published: 24 October 2015 Springer Science and Business Media LLC
    The aim of this study is to determine the incidence and causes for cochlear explantation/re-implantation in children as a retrospective case review in a Quaternary paediatric Cochlear Implant (CI) Centre. The subjects included in the study were Paediatric CI patients requiring cochlear explantation/re-implantation. Outcome measurements were incidence and aetiology of device explantation/re-implantation. Patient age at implantation, aetiology of deafness, CI manufacturer, and timing of explantation/re P implantation were the independent variables. 778 paediatric cochlear implants were performed in 653 children between 1992 and January 2013. There were a total of 40 (5.1 %) failed implants in 38 patients. The most common reason for explantation was device failure in 22 (2.8 %). Risk factors for device failure were known manufacturing defect/device recall. Medical/surgical issues accounted for 18 (2.3 %) implant failures. The mean time to explantation was 3 years 10 months. The incidence of explantation/re-implantation in our paediatric cochlear implant population is comparable to other published studies. The most common reason for explantation was device failure, however, the aetiology of deafness, in particular meningitis, does not appear to increase the risk of explantation as described in previous series.

  • Imaging modalities in children with vascular ring and pulmonary artery sling
    Benedetta Leonardi, Aurelio Secinaro, Renato Cutrera, Sonia Albanese, Marilena Trozzi, Alessio Franceschini, Valentina Silvestri, Paolo Tomà, Adriano Carotti, and Giacomo Pongiglione

    Pediatric Pulmonology, ISSN: 87556863, eISSN: 10990496, Pages: 781-788, Published: 1 August 2015 Wiley
    Our aim is to compare new non‐invasive imaging modalities in the evaluation of vascular ring (VR) and pulmonary artery sling (PAS) and to understand the role of bronchoscopy in comparison with them in assessing tracheobronchial tree.

  • Nasal dermoids in children: A proposal for a new classification based on 103 cases at Great Ormond Street Hospital
    B.E.J. Hartley, N. Eze, M. Trozzi, S. Toma, R. Hewitt, C. Jephson, L. Cochrane, M. Wyatt, and D. Albert

    International Journal of Pediatric Otorhinolaryngology, ISSN: 01655876, eISSN: 18728464, Pages: 18-22, Published: 1 January 2015 Elsevier BV
    OBJECTIVES Nasal dermoids are rare developmental anomalies seen in children. This study reports the largest case series of 103 patients seen in a quaternary specialist unit over a 10-year period. We report the surgical and radiological findings and propose a new classification system, which clearly describes the extent of the lesions, thus allowing better surgical planning. METHODS A retrospective review of case notes was conducted. Data collection included demographics, initial presentation, site of lesion, pre-operative CT and MRI imaging, surgical procedure, intraoperative findings (including depth of lesion), complications and recurrence. Surgical findings were correlated with radiological findings. RESULTS A total of 103 patients were included in the study. The mean age at presentation was 29 months. 89% of children presented with a naso-glabellar or columellar lesion and 11% had a medial canthal lesion. All the patients underwent preoperative imaging and were treated with surgical excision. 58 children had superficial lesions, 45 had subcutaneous tracts extending to varying depths. Of these, 38 had intraosseous extension into the frontonasal bones, eight extended intracranially but remained extradural and two had intradural extension. There was good correlation between radiological and surgical findings. The superficial lesions were locally excised. The lesions with intraosseous tracts were removed via open rhinoplasty and the frontonasal bones drilled for access. Intracranial extension was approached either via a bicoronal flap and frontal craniotomy or the less invasive anterior small window craniotomy. CONCLUSIONS This report describes the largest published cases series of nasal dermoids. The cases demonstrate the presenting features and the variable extent of the lesions. The new proposed classification; superficial, intraosseous, intracranial extradural and intracranial intradural, allows precise surgical planning. In the presence of intracranial extension, the low morbidity technique of using a brow incision and small window anterior craniotomy avoids the more invasive and commonly used bicoronal flap and frontal craniotomy.

  • Resolution of opisthotonus in respiratory distress by aortopexy
    M. Trozzi, V. Briganti, A. Conforti, A. Schiavino, and S. Bottero

    International Journal of Pediatric Otorhinolaryngology, ISSN: 01655876, eISSN: 18728464, Pages: 1372-1373, Published: August 2013 Elsevier BV
    We report a case of worsening respiratory distress associated with opisthotonus secondary to tracheomalacia, a rather unique pathophysiological phenomenon. A 2-month-old male baby was referred to our hospital for respiratory distress syndrome with a noticeable opisthotonus. Examination and investigation confirmed the presence of an aberrant innominate artery compressing the trachea. The infant underwent aortopexy and made a dramatic post-operative recovery. Of special note, the opisthotonus vanished soon after the operation. Opisthotonus is not always related to neurological impairment and may be a warning sign of mediastinal overcrowding in patients with respiratory distress syndrome secondary to vascular compression.

  • The Susy Safe project overview after the first four years of activity
    D. Gregori, F. Foltran, S. Ballali, P. Berchialla, H. Rodríguez, P. Zaupa, P. Spitzer, Costantinos Demetriades, I. Šlapák, L. Sokolova, E. Petridou, Antonella D'Alessandro, Manuel Antonio CaldeiraPais Clemente, Jana Jakubíková, S. V. As, T. Koning, D. Passali, Alberto Chinsky, F. Brkić, R. Mladina, Olga Kalakouta, Andreas Melis, Michaela Máchalová, P. Cayé‐Thomasen, Enas I El-Sheikh, Ahmed Ragab, A. Pitkäranta, Philippe Contencin Necker, J. Derelle, Magali Duwelz, M. François, S. Pezzettigotta, C. Righini, J. Buzarov, Roehrich Bernhard, V. Jahnke, G. Onder, Petra Zieriacks, Vicky Kalampoki, Nikola Simasko, C. Skoulakis, A. Camaioni, C. Cutrone, E. Gaudini, D. L. Grasso, N. Mansi, G. Messi, C. Orlando, Sabino Preziosi, I. Sorrentini, M. Trozzi, A. Vigo, Giuseppe Villari, G. Passali, F. Passàli, Y. Nishida, Gainel Ussatayeva, Ricardo DeHoyos, Fe Ologe, M. Nasrullah, A. Meléndez, Mieckzyslaw Chmielik, Teresa Belchior, M. D. Cobzeanu, D. Gheorghe, Adelaida Iorgulescu, Codrut Caius, M. Toader, Jana Barkóciová, Beata Havelková, M. Žargi, F. Pumarola, L. Rubio, P. Stierna, Wei-Chung Hsu, Sakda Arj-Ong, C. Chomchai, L. Hoep, Rico Rinkel, ErdincAydin Baskent, V. Erikci, M. Önerci, J. Graham, S. Khwaja and C. Raine

    International Journal of Pediatric Otorhinolaryngology, ISSN: 01655876, eISSN: 18728464, Issue: SUPPL. 1, Published: 14 May 2012 Elsevier BV
    OBJECTIVES to collect relevant, up-to-date, representative, accurate, systematic information, related to foreign bodies (FB) injuries. METHODS The "Susy Safe" registry, a DG SANCO co-funded project gathering data on choking in all EU Countries and beyond, was established in order to create surveillance systems for suffocation injuries able to provide a risk-analysis profile for each of the products causing the injury. Main findings after 4 years of activities are resumed here. RESULTS 16,878 FB injuries occurred in children aged 0-14 years have been recorded in the SUSY SAFE databases; 8046 cases have been reported from countries outside EU. Almost one quart of the cases involving very young children (less than one year of age) presented a FB located in bronchial tract, thus representing a major threat to their health. Esophageal foreign bodies are still characterizing injuries occurred to children younger than one year, in older children the most common locations are the ears and the nose. FB type was specified in 10,564 cases. Food objects represented the 26% of the cases, whereas non-food objects were the remaining 74%. Among food objects, the most common were bones, nuts and seed, whereas for the non-food objects pearls, balls and marbles were observed most commonly (29%). Coins were involved in 15% of the non-food injuries and toys represented the 4% of the cases. CONCLUSIONS this data collection system should be been taken into consideration for the calculation of the risk of injuries in order to provide the EU Commission with all the relevant estimates on FB injuries.

  • Food foreign body injuries
    Arjan B. (Sebastian) van As, Abdullah M. Yusof, and Alastair J.W. Millar

    International Journal of Pediatric Otorhinolaryngology, ISSN: 01655876, eISSN: 18728464, Issue: SUPPL. 1, Published: 14 May 2012 Elsevier BV
    RATIONALE AND AIM The purpose of this study is to acquire a better understanding of Food Foreign Bodies (FFB) injuries in children characterizing the risk of complications and prolonged hospitalization due to food items according to patients' characteristics, circumstances of the accident, Foreign Body (FB) features and FB location, as emerging from the SUSY Safe Web-Registry. METHODS The present study uses data provided by the SUSY Safe Project, a DG SANCO co-funded project started in February 2005, which was aimed at establishing an international registry of cases of Foreign Bodies (FB) injuries in children aged 0-14 years. The analysis was carried out on injuries due to a food item. FB location was reported according to ICD9-CM code: ears (ICD931), nose (ICD932), pharynx and larynx (ICD933) trachea, bronchi and lungs (ICD934), mouth, esophagus and stomach (ICD935). Age and gender injury distributions were assessed. Data regarding adult supervision and activity before injury were also evaluated. FBs which most frequently cause complications were identified. The association between children age, adult presence, object characteristics and hospitalization/complications was computed using unweighted odds ratios and the related 95% confidence intervals. RESULTS 16,878 FB injuries occurred in children aged 0-14 years have been recorded in the SUSY Safe databases. FB type was specified in 10,564 cases; among them 2744 (26%) were due to a food item. FB site was recorded in 1344 cases: FB was located in the ears in 99 patients, while 1140 occurred in the upper and lower respiratory tract; finally, 105 food items were removed from mouth, esophagus and stomach. Complications occurred in 176 cases and the most documented was pulmonary or bronchial infections (23%) followed emphysema or atelectasis and by and asthma (7%). Bones were the commonest retrieved FFB encountered in this study, while nuts seem to be the FFB most frequently associated to complications. CONCLUSIONS On the basis of this study we make the strong recommendation that parents should be adequately educated and provide age-appropriate food to their children and be present in order to supervise them during eating especially during a critical period ranging from 2 to 3 years of age.