Phd in INNOVATIVE BIOTECH SOLUTIONS FOR SENSORY ORGANS
DISEASES

Thesis title: Forced Oscillation Technique: un approccio innovativo per la diagnosi e prevenzione della broncopneumopatia ostruttiva nei pazienti sottoposti a laringectomia totale

Background: Total laryngectomy remains the definitive treatment for advanced laryngeal carcinoma but leads to profound respiratory alterations due to the loss of the upper airway’s physiological conditioning functions. As a consequence, chronic respiratory complications—often with obstructive features—are frequent but difficult to diagnose with traditional otorhinolaryngological and radiological methods. Objective: The present study aimed to evaluate the applicability of the Forced Oscillation Technique (FOT) as an innovative, non-invasive, and easy-to-perform method for assessing respiratory function in patients who have undergone total laryngectomy, with the goal of identifying early signs of chronic obstructive pulmonary disease (COPD). Methods: Sixty patients were recruited at the Department of Sense Organs, Policlinico Umberto I – Sapienza University of Rome. After applying exclusion criteria, 32 patients were included in the final analysis. Each subject underwent an ENT examination, tracheoscopy, and oscillometric testing using the Resmon ProFull Restech device, connected to the tracheostoma via a custom 3D-printed adapter. Inspiratory resistance (Rinsp) was measured at 5, 11, and 19 Hz and analyzed in correlation with clinical and demographic variables. Results: Statistical analysis showed a positive correlation between Rinsp and both patient age, body mass index (BMI), and time elapsed since surgery. Conversely, a strong negative correlation was found between Rinsp and daily usage time of HME (Heat and Moisture Exchanger) filters. Patients primarily using the “Home” HME filter, characterized by higher humidification capacity, demonstrated significantly lower inspiratory resistance compared to those using the “Go” filter, underscoring the protective role of proper tracheostomal management. Conclusions: The findings suggest that post-laryngectomy respiratory impairment results from progressive cito-architectural changes of the airway mucosa due to exposure to unconditioned air—a phenomenon mitigated by consistent use of appropriate HME devices. FOT emerges as a promising, minimally invasive tool for the early diagnosis and monitoring of obstructive airway disease in total laryngectomy patients, paving the way for standardized clinical guidelines and multidisciplinary management strategies in this population.