The efficacy and tolerability of Serratia peptidase were evaluated in a multicentre, double-blind, placebo-controlled study of 193 subjects suffering from acute or chronic ear, nose or throat disorders. Treatment lasted 7-8 days, with the drug or placebo being administered at a rate of two tablets three times a day. After 3-4 days' treatment, significant symptom regression was observed in peptidase-treated patients. There was also a significant reduction in symptoms after 7-8 days for patients in both treatment groups but the response was more marked in those patients receiving the active drug. Statistical comparison between the two groups confirmed the greater efficacy and rapid action of the peptidase against all the symptoms examined at both stages. Tolerance was found to be very good and similar for both groups. It is concluded that Serratia peptidase has anti-inflammatory, anti-oedemic and fibrinolytic activity and acts rapidly on localized inflammation.

Airway stenting is the chosen treatment for patients affected by subglottic tracheal stenosis and unfit for surgery. Among the different types of prostheses, the Dumon stent is a valid option especially in patients without tracheotomy. Insertion is usually achieved by pushing the stent off from a loader using a prosthesis pusher. If the stent is expelled below the stenosis, rigid forceps grasping the proximal end of the stent retract it above the stenosis. However, in difficult cases such as rigid stenosis with a luminal diameter smaller than the profile of the stent, such a manoeuvre may be difficult in non-expert hands. Thus, we proposed a simple and safe technique to facilitate the placement of a Dumon stent. We passed a long thread from outside to the inside of the stent. After the dilatation of the stenosis, the stent was pushed and, if needed, easily retracted with the thread into the proper position to ensure airway patency and to avoid migration. In addition, our procedure could be useful also to rapidly remove the stent if its size turned out to be inaccurate for the stenosis. With such a simple method we successfully treated 7 consecutive patients affected by complex subglottic stenosis and unfit for surgery.

We report a case of granulations that complicated subglottic stent placement and completely destroyed vocal folds with luminal stent obstruction. A microbial aetiology significantly contributed to the occurrence of granulations associated with mechanical irritation. The granulations were successfully resected using a digital AcuBlade laser system, a new generation of CO2 laser used in otorhinolaryngology, particularly in vocal cord disease. It permitted a precise control of the scan line between vocal fold and granulation for several reasons. The scan line was completely electronic and integrated in the scanner. The sweep in speed was constant and the energy distribution was uniform along the entire length of the time. The interpulse pause was of ∼1 ms, allowing the tissue cooling with reduction of thermal spread and quicker healing support. The result was the radical excision of granulations without injuring vocal folds. The respiratory function was restored and no other treatments such as arytenoidectomy or cordectomy associated with the alteration of phonatry function were required. No intraoperative or/and postoperative complications were registered and the patient was discharged 7 days after the procedure.