Insubria ENT School

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Treated Pathologies

The Insubria ENT School represents a point of reference in otorhinolaryngological training and research. Our multidisciplinary approach encompasses the study of various pathologies, allowing us to offer comprehensive and innovative training programs.

Skull Base

The continuous refinement of minimally invasive surgical techniques, such as endonasal endoscopy, enables the performance of highly precise interventions, with clear benefits in terms of reduced postoperative recovery times and complication rates. In cases where the extent of the pathology does not allow for a minimally invasive approach, more extensive surgical procedures become necessary, such as craniofacial and cranio-endoscopic approaches. These require the involvement of multidisciplinary teams, in collaboration with neurosurgeons, maxillofacial surgeons, plastic surgeons, oncologists, and radiation therapists.

To complement the diagnostic and therapeutic pathway, specialized second-level endoscopic outpatient clinics are active, dedicated to the follow-up and management of specific pathologies, including benign and malignant nasosinusal tumors, cerebrospinal fluid rhinorrhea fistulas, and sellar pathology.

Main Pathologies

Benign Tumor Pathologies:

  • Fibro-osseous lesions (FOLs: osteomas, ossifying fibromas, fibrous dysplasia)

  • Meningiomas

  • Schwannomas

Malignant Tumor Pathologies:

  • Intestinal and non-intestinal type adenocarcinomas (ITAC)

  • Squamous cell carcinomas

  • Olfactory neuroblastomas

  • Mucosal melanomas

  • Adenoid cystic carcinomas

  • Neuroendocrine carcinomas

  • Undifferentiated carcinomas

  • Sarcomas

  • Glomangiopericytomas

  • Nasosinusal metastases

Sellar Tumor Pathologies:

  • Pituitary adenomas

  • Craniopharyngiomas

Nasopharyngeal Tumor Pathologies:

  • Nasopharyngeal carcinomas

  • Salivary gland carcinomas

Clivus Pathologies:

  • Chordomas

  • Chondrosarcomas

Other:

  • Spheno-orbital meningiomas

  • Juvenile nasopharyngeal angiofibroma (JNA)

  • Cerebrospinal fluid rhinorrhea fistulas (post-traumatic, iatrogenic, idiopathic intracranial hypertension), meningoceles, meningoencephaloceles

  • Cholesterol granuloma of the petrous apex

  • Skull base osteonecrosis/osteomyelitis (including radio-induced forms)

Main Treatments

  • Transnasal endoscopic resection

  • Endoscopic resection with transnasal craniectomy (ERTC) with multilayer skull base reconstruction

  • Craniofacial approaches

  • Cranioendoscopic approaches

  • Multiportal approaches (transnasal, transorbital, transoral)

  • Endoscopic approaches to the pterygopalatine/infratemporal fossa

  • Endoscopic approaches to the sellar and clival regions

  • Skull base reconstruction (plastic surgery)

Orbit and Lacrimal Pathways

The involvement of the otorhinolaryngologist in managing orbital and lacrimal pathway diseases is based on the close anatomical and functional relationship these structures share with the nasosinusal district. Moreover, many orbital conditions require a multidisciplinary approach involving collaboration between the otorhinolaryngologist, ophthalmologist, and endocrinologist.

Main Pathologies

  • Lacrimal duct diseases: stenosis of the lacrimal ducts, acute/chronic dacryocystitis, dacryocystopyocele

  • Orbital complications of sinusitis: orbital cellulitis, orbital abscess

  • Benign orbital pathologies: venous malformations such as cavernous hemangioma

  • Spheno-orbital meningiomas

  • Graves’ orbitopathy (Basedow’s orbitopathy)

  • Orbital pseudotumor

  • Optic neuropathy: post-traumatic, iatrogenic, or due to Graves’ orbitopathy

  • Orbital involvement of malignant nasosinusal tumors

Main Treatments

  • Endoscopic dacryocystorhinostomy, possibly with lacrimal stent placement

  • Reconstruction of Hasner’s valve

  • Functional endoscopic sinus surgery (possibly with orbital decompression and drainage of orbital abscess)

  • Endoscopic transnasal removal of intraorbital pathology

  • Multiportal approaches (endoscopic transnasal + transpalpebral superior eyelid)

  • Orbital decompression (medial endoscopic and possibly balanced)

  • Optic nerve decompression

  • Orbital exenteration

Rhinology and Nasosinusal Pathology

Rhinologic pathology represents a fundamental area of clinical activity. The main conditions treated include nasal breathing disorders, acute and chronic rhinosinusitis, recurrent allergic rhinitis, non-allergic rhinitis, and primary and secondary ciliary dyskinesias, diagnosed through phase-contrast microscopy. An accurate diagnosis allows for targeted and personalized therapies.

At the rhinology outpatient clinic and endoscopic clinics, the following procedures are performed: nasal endoscopy with rigid optics; Skin Prick Test and advanced allergy tests (RAST, Prick by Prick); nasal cytology for the identification of cellular rhinitis, biofilms, and dyskinesias; rhinomanometry, both basal and post-vasoconstriction.

In the allergology field, specific immunotherapy is prescribed for the main allergens. Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) are followed in the endoscopic clinics, and patients undergoing treatment with biologic drugs are managed in dedicated outpatient clinics.

Main Pathologies

  • Epistaxis (including treatment of HHT/Rendu-Osler-Weber syndrome)

  • Vasomotor, allergic, and non-allergic rhinitis (NARES, NARESMA, NARNE, NARMA)

  • Ciliary dyskinesias

  • Nasal septum deviation

  • Nasal septum perforation (iatrogenic/induced)

  • Inferior turbinate hypertrophy

  • Acute and chronic rhinosinusitis, with or without nasal polyposis

  • Complicated sinusitis (orbital cellulitis, orbital abscesses, intracranial abscesses)

  • Mucoceles

  • Benign nasosinusal tumors: inverted papillomas, schwannomas, hemangiomas

Main Treatments

  • Specific immunotherapy

  • Turbinoplasty with radiofrequency, argon laser, or diode laser

  • Septoplasty (traditional/endoscopic)

  • Septal perforation repair

  • Functional endoscopic sinus surgery (FESS/ESS)

  • Transnasal endoscopic resection, endoscopic medial maxillectomy (TEPM)

Smell and Taste

Alterations of smell and taste, often occurring together, have various causes (viral, obstructive, neoplastic) and significantly impact quality of life. At the dedicated second-level outpatient clinic, specific tests are performed including olfactometry (baseline, identification, discrimination, threshold testing using Sniffin’ Sticks, retronasal, and pediatric testing with U-Sniff) and gustometry (screening and comprehensive).

Except for cases treatable by surgery, the main treatment is personalized olfactory and gustatory training. The facility is accredited by the Clinical Olfactory Working Group (COWoG) and is part of the Italian Smell and Taste Group (GIOG).

Main Pathologies

  • Hyposmia

  • Anosmia

  • Cacosmia

  • Phantosmia

  • Hypogeusia

  • Dysgeusia

Main Treatments

  • Olfactory training

  • Nasosinusal surgery

Pediatric Otolaryngology

The Simple Pediatric Otorhinolaryngology Unit at Del Ponte Hospital is responsible for the diagnosis and medical and surgical treatment of the main otorhinolaryngological diseases in pediatric age. Activities are carried out on an outpatient basis, Day Hospital, and ordinary hospitalization.

Particular attention is given to adenoidal and tonsillar hypertrophy, otitis, sinusitis, and sleep respiratory disorders, including obstructive sleep apnea syndrome (OSAS). The team is also specialized in managing rare diseases, such as cerebrospinal fluid fistulas, meningoceles, dermoid cysts, choanal atresia, and nasosinusal tumors, using minimally invasive endoscopic surgical techniques.

The management is multidisciplinary, in close collaboration with pediatricians, pediatric surgeons, neurosurgeons, pulmonologists, maxillofacial surgeons, audiovestibologists. Multidisciplinary visits are also active in the following second-level outpatient clinics: ALTE clinic, OSAS and sleep disorders clinic, oral pathology clinic, swallowing clinic, neurogastroenterology clinic, complex surgical malformations clinic.

Main Pathologies

  • Adenoidal hypertrophy

  • Tonsillar hypertrophy

  • Peritonsillar abscess

  • Inflammatory and infectious diseases of the nose and paranasal sinuses

  • Oncological diseases of the nose and paranasal sinuses (benign and malignant tumors)

  • Cerebrospinal fluid fistulas

  • Choanal atresia

  • Infectious or neoplastic diseases of the neck

  • Thyroglossal duct cysts

  • Thyroid diseases

  • Laryngomalacia

  • Otitis media (effusive, secretory, acute or chronic, and cholesteatomatous); otomastoiditis

  • Adenoidal hypertrophy

  • Tonsillar hypertrophy

  • Peritonsillar abscess

  • Inflammatory and infectious diseases of the nose and paranasal sinuses

  • Oncological diseases of the nose and paranasal sinuses (benign and malignant tumors)

  • Cerebrospinal fluid fistulas

  • Choanal atresia

  • Infectious or neoplastic diseases of the neck

  • Thyroglossal duct cysts

  • Thyroid diseases

  • Laryngomalacia

  • Otitis media (effusive, secretory, acute or chronic, and cholesteatomatous); otomastoiditis

Main Treatments

  • Adenoidectomy

  • Adenotonsillectomy, drainage of peritonsillar abscess

  • Functional endoscopic sinus surgery

  • Repair of cerebrospinal fluid fistula

  • Repair of choanal atresia

  • Neck surgery (removal of thyroglossal duct cysts, thyroidectomy, lymphadenectomy)

  • Ear surgery (myringoplasty, tympanoplasty, mastoidectomy)

Cervical District Pathology

The cervical district represents a complex anatomical area, often affected by inflammatory, congenital, or neoplastic conditions that require accurate diagnostic and therapeutic assessment, given the proximity to vital structures and the clinical variability with which they may present. In managing these pathologies, especially in the oncological field, collaboration with other specialists such as endocrinologists, oncologists, radiation therapists, nuclear medicine physicians, pathologists, maxillofacial surgeons, plastic surgeons, physiatrists, and speech therapists is essential.

Surgical activities are carried out under ordinary hospitalization, while outpatient activities are characterized by second-level clinics (phoniatrics clinic, ENT-oncology and radiation therapy clinic, thyroid clinic).

Main Pathologies

  • Inflammatory diseases of the head and neck region: chronic tonsillitis, peritonsillar abscesses, retropharyngeal abscesses, odontogenic abscesses, cervical abscesses, necrotizing fasciitis, sialolithiasis and sialoadenitis of the parotid and submandibular glands

  • Malignant tumors of the head and neck region: malignant tumors of the oral cavity, oropharynx (tonsil, base of tongue, soft palate), larynx, hypopharynx, lateral cervical metastases from skin tumors (melanomas, squamous cell carcinomas), tumors of unknown primary origin

  • Benign laryngeal diseases: Reinke’s edema, vocal cord nodules/cysts/polyps, laryngoceles

  • Benign and malignant tumors of the salivary glands

  • Benign and malignant thyroid diseases: thyroglossal duct cysts, adenomas, hyperthyroidism (Graves’ disease), goiters, carcinomas

  • Benign and malignant parathyroid diseases: hyperparathyroidism, adenomas, carcinomas

Main Treatments

  • Tonsillectomy

  • Drainage of cervical abscesses via cervicotomy

  • Submandibular sialectomy and parotidectomy

  • Transoral surgery, glossectomies, compartmental tongue surgery

  • Transoral laser laryngeal surgery, total laryngectomy, reconstructive laryngectomy, total hypopharyngolaryngectomy

  • Lymphadenectomy, lateral cervical dissection

  • Hemithyroidectomy, total thyroidectomy (possibly with lateral cervical dissection/sternotomy)

  • Parathyroidectomy

Sleep Disorders

Snoring and obstructive sleep apnea syndrome (OSAS) are nocturnal respiratory disorders that can occur together or separately, in both adults and children. Although snoring is often considered benign, it may indicate the presence of OSAS, a more serious condition with potential cardiovascular and neurological consequences.

At the dedicated clinic, patients undergo a comprehensive evaluation including airway endoscopy, polysomnography, and sleep endoscopy in a Day Surgery setting. The diagnostic and therapeutic pathway is supported by a multidisciplinary team composed of maxillofacial surgeons, pediatricians, pulmonologists, and dentists.

The proposed therapies include ventilatory therapy (CPAP, BiPAP), oxygen therapy, mandibular advancement devices, and minimally invasive surgeries (radiofrequency under local anesthesia, pharyngoplasty, nasal surgery). The center is accredited by AIR (Italian Academy of Roncology)

Main Pathologies

  • Obstructive Sleep Apnea Syndrome (OSAS)

  • Snoring

Main Treatments

  • Radiofrequency on the palate

  • Turbinoplasty

  • Pharyngoplasty

  • Ventilatory therapy (CPAP, AutoCPAP, BiPAP)

  • MAD (Mandibular Advancement Device)

  • Radiofrequency on the palate

  • Turbinoplasty

  • Pharyngoplasty

  • Ventilatory therapy (CPAP, AutoCPAP, BiPAP)

  • MAD (Mandibular Advancement Device)

Otology

The oto-surgical clinic is a specialized second-level service dedicated to the diagnosis and treatment of ear diseases through otomicroscopy and otoendoscopy. It manages conditions treatable with medical therapy such as otitis externa and acute otitis media, as well as diseases requiring surgical intervention like cholesteatomatous otitis media or otosclerosis.

Surgery is performed in Day Hospital, Day Surgery, and ordinary hospitalization settings for more invasive procedures. Post-operative follow-up is conducted at the same clinic to ensure comprehensive patient care.

Main Pathologies

  • Acute/chronic otitis media

  • Catarrhal otitis

  • Cholesteatomatous otitis

  • Tinnitus

  • Hearing loss

  • Otosclerosis

  • Acoustic neuroma

  • Labyrinthine fistulas

  • Vertigo

Main Treatments

  • Transtympanic drainage

  • Open and closed tympanoplasty

  • Myringoplasty

  • Ossiculoplasty

  • Stapedotomy

  • Mastoidectomy, petrosectomy

Adult and Pediatric Voice Disorders Clinic

Every Monday morning, at one of the otolaryngology outpatient clinics, examinations are performed on adults and children with voice disorders including: dysphonia due to vocal cord nodules, dysphonia from lack of pneumophonic coordination, dysphonias from benign or malignant vocal cord lesions, dysphonias following previous laryngeal surgery (benign or malignant), hyperkinetic dysphonias, conversion dysphonias, spasmodic dysphonias, aphonia, etc. Examinations are conducted by an otolaryngologist and a speech therapist specialized in voice disorders.

Main Pathologies

  • Dysphonia

  • Hyperkinetic dysphonias

  • Post-surgical dysphonias

  • Spasmodic dysphonias

  • Aphonia

Main Treatments

  • Speech therapy rehabilitation

  • Medical therapy

  • Surgical therapy

Language Disorders Clinic

According to literature data, it is estimated that about 10-20% of children under 3 years old present language development disorders, and more generally, developmental and neurodevelopmental disorders affect 15% of the entire population under 6 years of age.

Early identification of the disorder and timely rehabilitation therapy could reduce the difficulties faced by an increasing number of children, with preventive effects on the related disorders mentioned above.

At our clinic, held every Monday morning with the presence of a specialized otolaryngologist and speech therapist, phonetic-phonological disorders of children referred by their primary pediatrician or other specialists are recognized and treated. Children undergo fibrolaryngoscopy if necessary and are assessed to identify the problem and the required treatment.

Swallowing Disorders Clinic

Dysphagia literally means “eating poorly”; it is the difficulty or inability to chew, prepare, or swallow the bolus. It is a symptom that can originate from a structural or functional alteration of one or more structures involved in the swallowing process.

At the dedicated clinic, held every Wednesday at the Circolo Hospital, the second Thursday of the month at Angera Hospital, and the fourth Thursday of the month at Del Ponte Hospital within the multidisciplinary neurogastroenterology outpatient clinic, a specialist otolaryngologist-swallowing expert conducts a thorough patient history and performs an endoscopic evaluation of swallowing with foods of different consistencies, aimed at studying alterations of the swallowing mechanisms in the oro-pharyngeal tract.

Treated Pathologies

  • Dysphagia