Non-neoplastic recurrences in otorhinolaryngological diseases. Introduction| ACTA Otorhinolaryngologica Italica

Article

Otorhinolaryngology is a discipline that includes a wide variety of pathologies affecting anatomical districts with critical vital functions. The Otorhinolaryngologist is often called upon to provide complex therapeutical strategies for challenging diseases whose aetiopathogenesis relies on complex mechanisms, sometimes leading to disease chronicisation or relapses.

For disease relapse, it is intended the return of a disease or the signs and symptoms of a disease after a period of remission due to the persistence or re-exposition to the same risk factors or pathogens.

Depending on the severity of the disease relapse, patients may be affected by the same clinical signs and symptoms or, in some cases, present with more severe symptoms due to disease progression or complications.

The term “relapse” is more commonly adopted in oncology, and refers to the return of the tumour, loco-regionally or with distant metastasis, after it has been successfully treated with surgical or non-surgical therapeutic protocols.

In the literature, many authors have widely investigated the aetiopathogenetic factors underlying cancer relapses, and even nowadays, there are several active protocols aimed at better defining such unknown phenomena.

Considering this massive attention directed to the head and neck oncology field, we have decided to focus on the less investigated and still mysterious mechanisms underlying non-neoplastic disease relapses in otorhinolaryngology.

The 2023 Official Report includes three segments focusing on the most represented non-oncologic pathologies in all three branches of otorhinolaryngology:

1. Rhinology
2. Otology
3. Head and Neck

The main aspect that defines an event as a relapse of disease is that it must occur after a certain period of time without any disease-related sign, symptom or alteration in the commonest blood chemistry analysis or diagnostic investigations. Although there is no general consensus about the definition of the time interval between disease remission and relapse, it is believed to be at least several weeks.

Another aspect that needs to be better specified is the distinction between disease relapse and recurrence. The latter refers to a disease that has clinically come back, usually after a period of time during which the disease itself could be undetectable.

A representative example of recurrent disease is laryngeal papillomatosis, where the pathogen is the human Papillomavirus, and the clinical recurrences are due to multifactorial aetiopathogenesis (non-radical surgery, multifocal viral infection, etc.).

In other cases, disease relapses are due to still unknown aetiopathogenetic factors, thus burdening treatment results and surgical outcomes as for nasal polyposis or chronic otitis media with cholesteatoma.

Due to their complexity and multifactorial nature, some challenging chronic diseases are managed with a multidisciplinary approach, both medical and surgical. For such chronic diseases, patients often suffer from unsatisfactory therapies and frustration from non-resolutive surgeries. The role of the Otorhinolaryngologist is to guide the patient through long-lasting therapeutic protocols, thus defining the best surgical timing, whether necessary and providing effective patient counselling to preserve the doctor-patient relationship.

In several cases, it is essential to stress the role of some primary prevention measures, such as the HPV vaccination campaign for laryngeal papillomatosis, or the importance of effective counselling about nasal hygiene in patients affected by nasal polyposis, or, furtherly, the sensibilisation towards experimental medical therapies in patients affected by benign positional parossistic vertigo.

In other cases, patients suffer from the consequences of inadequate primary surgery. Thus, the most effective strategy to avoid disease relapses is to provide medical treatment or surgical protocols according to the current best standards of care.

Finally, from a comparative reading of the manuscripts included in the 2023 Official Report, it should be highlighted that most authors summarise the conclusions of their scientific contributions in the form of algorithms or flowcharts, thus suggesting the emerging role of artificial intelligence in Otorhinolaryngologist practice.

The 2023 Official Report aims to unravel the most significant problems related to the diagnosis and treatment of non-neoplastic disease recurrences in the otorhinolaryngological field and includes the contribution of the most representative Italian Tertiary Centres. It is intended to stimulate the attention of specialists on an important topic which, at times, also exposes us to important medico-legal problems.

Marco Benazzo