Ear, Nose And Throat Symptoms Research Articles

Dupilumab for relapsing or refractory sinonasal and/or asthma manifestations in eosinophilic granulomatosis with polyangiitis: a European retrospective study

BackgroundEosinophilic granulomatosis with polyangiitis (EGPA) is often associated with glucocorticoid-dependent asthma and/or ear, nose and throat (ENT) manifestations. When immunosuppressants and/or mepolizumab are ineffective, dupilumab could be an option. We...

Ear, nose, and throat manifestations of COVID-19 and its vaccines.

Coronavirus disease 2019 (COVID-19) is a highly infectious disease and was designated a pandemic by the World Health Organization (WHO) on March 11, 2020. There are no classical manifestations of the disease. The most prevalent symptoms include fever, cough, dyspnea, myalgia and headache. The main route of transmission of the severe acute respiratory syndrome coronavirus-2 is through the upper respiratory tract. Therefore, it is not strange to find different ear, nose and throat (ENT) symptoms in individuals infected with this virus. Olfactory dysfunction is a common feature of COVID-19; either it is the only presenting symptom or it accompanies other manifestations of the disease. Other otolaryngological features such as sudden sensorineural hearing loss (SSNHL), dysphonia, nasal obstruction, sore throat, etc. are less frequent manifestations of COVID-19. These features, in addition, to being presented early in the disease process, certain long-standing symptoms like parosmia, dysphonia, and persistent deafness, are other characteristics of the disease. Geographical variation in otorhinolaryngological prevalence is another problem with this debilitating disease. Local and systemic adverse effects (local site injection pain, fever, myalgia, headache, and others) of the COVID-19 vaccines are more frequent than otolaryngological side effects (anosmia, hyposmia, Bell’s palsy, SSNHL, etc.). We aimed in this review to summarize the early and persistent ENT symptoms of COVID-19 or after the various COVID-19 vaccines.

ENT manifestations in HIV infected patients in PIMS Islamabad.

INTRODUCTION
 HIV is a global pandemic with estimation of 38 million active cases around the world according to WHO HIV data and statistics 2019. Despite of advancement in medical field the disease has not been tamed uptil now. In this modern era HIV is still considered a taboo in Pakistan, people are reluctant about disclosure of disease, screening of their partners and its treatment which is due to lack of awareness and socio-economic constraints.
 OBJECTIVE
 The aim of this study is to see the incidence of Ear, Nose and Throat (ENT) manifestations in HIV infected people presented in tertiary care hospital of Islamabad.
 MATERIAL AND METHOD
 A one-year observational cross-sectional study conducted in Pakistan Institute of Medical Sciences (PIMS) Islamabad between January 2019 to December 2019. All the HIV infected patients who presented with ear, nose and throat manifestations were recruited in the study. Detailed history and examination were conducted after taking written consent. Analysis included calculations of mean values of quantitative association between ENT symptoms and demographic characteristics. Statistical analysis was estimated using either Chi-square test or t-test. 
 RESULTS 
 Majority of the patients presented with Otological manifestation of which the most common was chronic suppurative otitis media (14.28%). Most common Rhinological/Oropharyngeal manifestation included epistaxis (12.24%) and oral candidiasis (8.16%) respectively. Among neck manifestations cervical lymph adenopathy (18.16%) showed the highest percentage.
 CONCLUSION
 The study shows a local trend of ENT manifestation in which the patient presented in later stage (WHO III) which resembled to the studies carried out in other developing countries showing ineffectiveness of current national HIV/AIDS programme.

Response to mepolizumab according to disease manifestations in patients with eosinophilic granulomatosis with polyangiitis

BackgroundEosinophilic granulomatosis with polyangiitis (EGPA) is a relapsing disease with frequent glucocorticoid dependence. Mepolizumab has been demonstrated to reduce flares and spare glucocorticoids (GC). However, EGPA is a heterogeneous condition and the effects of mepolizumab on specific disease manifestations has not been completely delimitated. ObjectivesTo analyse the impact of mepolizumab on manifestations derived from small-vessel vasculitis, ENT (ear, nose and throat) symptoms, asthma, eosinophilic tissue infiltration and anti-neutrophil cytoplasmic antibody (ANCA) status in a single-centre cohort of EGPA patients. MethodsMedical charts of EGPA patients treated with mepolizumab were retrospectively reviewed by the authors to describe demographics, clinical characteristics, steroid dose at the initiation of mepolizumab and during follow-up, flares, disease activity, damage accrual and laboratory results. Results and conclusionsAmong 56 patients with EGPA regularly controlled at our department, 11 patients were treated with mepolizumab because of corticodependence and unsatisfactory disease control. The mean time of treatment was 38 months (range: 3-66 months). Patients with persistent symptoms improved their asthma control, but 3 of them persisted with recurrent ENT symptoms in spite of treatment with mepolizumab. None of the patients developed vasculitic manifestations (cutaneous, neurological, gastrointestinal, renal) during treatment. All patients achieved a Birmingham Vasculitis Activity Score (BVAS) of 0 points at 12 months or earlier. In general, patients reduced the number of flares, which tended to be milder, and all related to asthma or ENT manifestations. The improvement in disease activity allowed notable glucocorticoid tapering.

Ear Nose and Throat (ENT) Manifestations in Granulomatosis with Polyangiitis in Patients from Saudi Arabia

Granulomatosis with polyangiitis (GPA) frequently affects ear, nose and throat (ENT) at disease onset. Our aim was to report on our experience with the ENT manifestations in GPA patients, therapy and outcome. A retrospective study of GPA patients was performed who followed up in Rheumatology clinics at King Khalid University hospital, Riyadh during the period 1990-2016. Demographics, different ENT manifestations, laboratory and diagnostic features, therapy and outcome of GPA patients were retrieved from their medical charts. ENT involvement was observed in 15 (65.2%) of the 23 GPA cases identified. Otologic symptoms were noted in 3 (13.0%), nose and sinus symptoms in 13 (56.5%) and throat symptoms in 3 (13.0%) GPA patients. Epistaxis (39.1%) was the most prevalent nose and sinus symptom followed by sinusitis (30.4%), otitis media and hearing loss were the frequent otologic symptoms, oral ulcers and hoarseness of voice constituted frequent throat symptoms in GPA patients. Of the 15 ENT-GPA patients, 9 were males and 6 were females (male: female; 1.5: 1). Their mean age at disease onset was 33.8 ± 18.3 (range 11-57) years and mean duration of disease was 10.1 ± 5.9 (range 1-20) years. ANCA was positive in 93.3% ENT-GPA patients, 73.3% had c-ANCA and 20.0% had p-ANCA. Infections were noted in 33.3% ENT-GPA patients that included pneumonia, septicemia, esophageal candidiasis, bacterial meningitis and herpes zoster. All patients received oral prednisolone, 60.0% received intravenous cyclophosphamide, 20.0% refractory cases received rituximab doses, and the disease outcome was good. Comparison of ENT- GPA with non- ENT GPA cohort showed that 26.7% ENT-GPA patients had renal involvement compared to 87.5% non ENT-GPA patients (p = 0.009). Our study showed that the frequency of ENT symptoms in our GPA patients was less compared to other studies, and the disease outcome was good. Renal involvement was significantly less frequent in ENT-GPA cohort compared to non ENT-GPA cohort.

SADDLE NOSE DEFORMITY FROM EOSINOPHILIC GRANULOMATOSIS WITH POLYANGIITIS: THE VERY FIRST CASE

SESSION TITLE: Pulmonary Pathology SESSION TYPE: Fellow Case Reports PRESENTED ON: 10/20/2019 01:00 pm - 02:00 pm INTRODUCTION: Eosinophilic granulomatosis with polyangiitis (EGPA) is a multisystem vasculitic disorder that predominantly affects medium and small sized blood vessels. EGPA belongs to a group of vasculitides known as anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV). Upper airway involvement is seen in all ANCA associated vasculitides, but destructive upper airway disease has never been reported in patients with EGPA. CASE PRESENTATION: A 50-year-old female with a history of difficult to control asthma for more than 15 years and chronic rhinitis presented to the hospital with severe jaw and ear pain. Vital signs on admission were unremarkable. Physical examination revealed bilateral mandibular tenderness and a normal appearing nasal mucosa. A CT scan of her neck with contrast demonstrated left maxillary sinus thickening and multiple nodules bilaterally at the lung apices. CT scan of the chest revealed bilateral nodules. A clinical diagnosis of EGPA was made and serologic work up was positive for perinuclear ANCA (P-ANCA) and Anti- myeloperoxidase (MPO-ANCA) antibody. Open lung biopsy was performed, and histopathology was consistent with necrotizing granulomatous vasculitis with extravascular eosinophilic infiltrate. She was treated with prednisone and azathioprine. Later on, she developed nonischemic cardiomyopathy. She was started on IV cyclophosphamide with good response. During an office visit, the patient was noted to have depressed nasal bridge with erythematous nasal mucosa. The patient underwent reconstruction of her nasal bridge and currently doing well. DISCUSSION: EGPA most commonly involves upper airway, peripheral nerves, skin and lungs. Destructive upper airway disease, such as saddle nose deformity (SND) is a well-known complication of other AAV, especially granulomatosis with polyangiitis (GPA) but has never been reported in EGPA patients. Other causes of SND include relapsing polychondritis, granulomatous infection, lymphomatoid granulomatosis, lymphoma, carcinoma and trauma. Ear, nose and throat (ENT) involvement is common with EGPA with a reported incidence of 48% on presentation. The most common symptoms include rhinitis, non-erosive sinusitis and nasal polyposis. According to five factors scoring (FFS) system presence of ENT symptoms is considered to convey a better prognosis. It is possible that the SND in our patient was a manifestation of severe systemic inflammation and developed slowly over a 2-year period. The severity of AAV have been proposed to be related to the type of autoantibody rather than the individual vasculitic syndrome. Presence of anti-proteinase 3 antibody (PR3-ANCA) is associated with worse disease severity and more chances of relapse. CONCLUSIONS: Erosive upper airway disease from EGPA has never been reported. We are reporting the first case of SND from EGPA with the hope to enrich the medical literature and encourage further research. Reference #1: Sinico RA, Bottero P. Churg-Strauss angiitis. Best practice & research Clinical rheumatology. 2009;23(3):355-66. DISCLOSURES: No relevant relationships by Scott Beegle, source=Web Response No relevant relationships by Biplab Kumar Saha, source=Web Response No relevant relationships by Aditi Saha, source=Web Response No relevant relationships by Boris Shkolnik, source=Web Response

Ear Nose and Throat (ENT) Manifestations in Granulomatosis with Polyangiitis in Patients from Saudi Arabia

Granulomatosis with polyangiitis (GPA) frequently affects ear, nose and throat (ENT) at disease onset. Our aim was to report on our experience with the ENT manifestations in GPA patients, therapy and outcome. A retrospective study of GPA patients was performed who followed up in Rheumatology clinics at King Khalid University hospital, Riyadh during the period 1990-2016. Demographics, different ENT manifestations, laboratory and diagnostic features, therapy and outcome of GPA patients were retrieved from their medical charts. ENT involvement was observed in 15 (65.2%) of the 23 GPA cases identified. Otologic symptoms were noted in 3 (13.0%), nose and sinus symptoms in 13 (56.5%) and throat symptoms in 3 (13.0%) GPA patients. Epistaxis (39.1%) was the most prevalent nose and sinus symptom followed by sinusitis (30.4%), otitis media and hearing loss were the frequent otologic symptoms, oral ulcers and hoarseness of voice constituted frequent throat symptoms in GPA patients. Of the 15 ENT-GPA patients, 9 were males and 6 were females (male: female; 1.5: 1). Their mean age at disease onset was 33.8 ± 18.3 (range 11-57) years and mean duration of disease was 10.1 ± 5.9 (range 1-20) years. ANCA was positive in 93.3% ENT-GPA patients, 73.3% had c-ANCA and 20.0% had p-ANCA. Infections were noted in 33.3% ENT-GPA patients that included pneumonia, septicemia, esophageal candidiasis, bacterial meningitis and herpes zoster. All patients received oral prednisolone, 60.0% received intravenous cyclophosphamide, 20.0% refractory cases received rituximab doses, and the disease outcome was good. Comparison of ENT- GPA with non- ENT GPA cohort showed that 26.7% ENT-GPA patients had renal involvement compared to 87.5% non ENT-GPA patients (p = 0.009). Our study showed that the frequency of ENT symptoms in our GPA patients was less compared to other studies, and the disease outcome was good. Renal involvement was significantly less frequent in ENT-GPA cohort compared to non ENT-GPA cohort.

Ear, nose and throat involvement in granulomatosis with polyangiitis: how it presents and how it determines disease severity and long-term outcomes.

Ear, nose and throat (ENT) manifestations in granulomatosis with polyangiitis (GPA) represent the most frequent symptoms at disease onset. The aim of the study was to analyse ENT involvement at diagnosis, as well as how it could influence relapse rate, mortality and disease severity. A retrospective non-controlled cohort study was performed including all consecutive diagnosed GPA from 1996 to 2016 in two rheumatology centres of Northern Italy, focusing particularly on ENT presenting signs and symptoms at baseline. Eighty-nine patients (48.3% females) with new onset GPA were evaluated. They were mostly Caucasian (97.7%), middle aged (mean 54.5years) and more frequently anti-neutrophil cytoplasmic antibodies (ANCA) positive (78.6%) with PR3 specificity (81.4%). At diagnosis, ENT involvement was reported in 71.9% patients, second only to systemic symptoms. These patients were significantly younger at disease onset (0.013), with less frequent renal involvement (0.014) irrespectively to ANCA status, but with significantly higher Vasculitis Damage Index (VDI) (0.001). The most frequent ENT manifestation was sinonasal involvement (58.4%, 73% of which with nasal inflammation/chronic sinusitis and 48% with nasal crusting), while otologic involvement (mainly otitis media/otomastoiditis) was observed in 34.8%. ENT-GPA patients presented a higher survival rate at 5years (98.1 vs 77.7%, 0.049), and ENT involvement resulted to be an independent predictor of better outcome (OR 0.37, 95% CI 0.2-0.8, 0.019). Our data confirms that ENT involvement is not only one of the key clinical features of GPA, but also could point out a milder GPA subset with lower renal involvement and lower mortality rate, irrespectively to ANCA status.

Efficacy and tolerability of a new nasal spray formulation containing hyaluronate and tobramycin in cystic fibrosis patients with bacterial rhinosinusitis

BackgroundChronic rhinosinusitis is common in cystic fibrosis (CF), as CFTR defects equally affect the airway and sinonasal mucosa. However, therapeutic strategies for CF-associated chronic rhinosinusitis lag behind current approaches for pulmonary disease. ObjectiveTo assess the tolerability and efficacy of a nasal spray formulation containing 0.2% sodium hyaluronate and 3% tobramycin compared to a control formulation containing 0.2% sodium hyaluronate alone in the treatment of bacterial rhinosinusitis in patients with CF. MethodsIn a double-blind controlled study, 27 patients with an established diagnosis of CF and a documented nasal infection with Pseudomonas aeruginosa and/or Staphylococcus aureus [22 males (81%), median age of 15years (range 5–26yrs)], were randomized to receive the nasal spray formulation containing hyaluronate and tobramycin (N=14) or hyaluronate alone (N=13) for 14days. Efficacy and local tolerability of the treatments were assessed by ear, nose and throat (ENT) examination and related symptoms. ResultsThe formulation containing hyaluronate and tobramycin was more effective than hyaluronate alone in improving the status of the nasal mucosa, in reducing the mucopurulent secretion at the level of the osteomeatal complex and in improving ENT symptoms (hyposmia/anosmia and headache/facial pain). The treatment was well tolerated without relevant side effects. ConclusionsThe present study suggests that the combination therapy with hyaluronate plus tobramycin was more effective than hyaluronate alone in the treatment of bacterial rhinosinusitis in CF. Trial registration number: EudraCT 2007-003628-39.

Ear, nose and throat (ENT) involvement in zoonotic diseases: a systematic review

Zoonoses are infections transmitted from animal to man, either directly (through direct contact or contact with animal products) or indirectly (through an intermediate vector, such as an arthropod). The causative agents include bacteria, parasites, viruses, and fungi. The purpose of this review is to make an accurate examination of all zoonotic diseases that can be responsible of ear, nose, and throat (ENT) involvement. A PubMed search was performed combining the terms (otorhinolaryngology OR rhinology OR laryngology OR otology OR mastoiditis OR otitis OR sinusitis OR laryngitis OR rhinitis OR pharyngitis OR epiglottitis OR dysphonia OR ear OR larynx OR nose OR pharynx) with each one of the etiological agents of zoonoses for the period between January 1997 and August 2012 without language restrictions. A total of 164 articles were selected and examined. Larynx was the most commonly involved ENT organ, followed by oral cavity, pharynx, and neck. Bacteria were the most representative microorganisms involved. Nose and major salivary glands were affected most frequently by protozoa; paranasal sinus, oral cavity, ear, neck, nerves and upper airway by bacteria; and larynx by fungi. ENT symptoms and signs may be present in many zoonotic diseases, some of which are also present in industrialized countries. Most zoonotic diseases are not commonly encountered by ENT specialists. Appreciation of the possible occurrence of these diseases is important for a correct microbiological approach, which often requires special culture media and diagnostic techniques.

Diagnosis and Treatment of HIV-Associated Manifestations in Otolaryngology

Almost 30 years after its first description, HIV still remains a global pandemic. The present paper aims to review the current knowledge on the ear, nose and throat (ENT) manifestations of HIV infection, and present the available diagnostic and treatment options. A literature review was conducted in Medline and other available database sources. Information from related books was also included in the data analysis. It is well acknowledged that up to 80% of HIV-infected patients eventually develop ENT manifestations; among which, oral disease appears to be the most common. Oro-pharyngeal manifestations include candidiasis, periodontal and gingival disease, HSV and HPV infection, oral hairy leucoplakia, Kaposi's sarcoma, and non-Hodgkin's lymphoma. ENT manifestations in the neck can present as cervical lymphadenopathy or parotid gland enlargement. Respective nasal manifestations include sinusitis (often due to atypical bacteria), and allergic rhinitis. Finally, otological manifestations include otitis (externa, or media), inner ear involvement (sensorineural hearing loss, disequilibrium), and facial nerve palsy (up to 100 times more frequently compared to the general population). Although ENT symptoms are not diagnostic of the disease, they might be suggestive of HIV infection, or related to its progression and the respective treatment failure. ENT doctors should be aware of the ENT manifestations associated with HIV disease, and the respective diagnosis and treatment. A multi-disciplinary approach may be required to provide the appropriate level of care to HIV patients.

How Useful the Combined Impedance-pH Monitoring Is for Evaluation of Refractory Reflux Symptoms?

TO THE EDITOR: I read with great interest the paper entitled Yield of combined impedance-pH monitoring for refractory reflux symptoms in clinical by Karamanolis et al,1 which was published in April 2011 issue of Journal of Neurogastroenterology and Motility. Esophageal impedance pH monitoring allows detection of reflux of any composition (liquid or gas) and pH (acid, weakly acid or non-acid). Many prevalence studies have suggested the relationship between weakly acid or non-acid reflux and residual symptoms in patients suspected to have gastroesophageal reflux disease (GERD).2,3 Prof. Karamanolis evaluated the yield of impedance pH monitoring in patients with persistent GERD symptoms on proton pump inhibitor (PPI) therapy. With symptom index analysis, 20.5% of patients showed symptoms receiving a diagnosis that could not have been achieved with pH testing alone. Fifty-two percent of patients reporting symptoms during the impedance-pH monitoring had no reflux-symptom association (non-GERD). Heartburn was the most prevalent symptom associated with acid reflux, whereas regurgitation and ear, nose and throat (ENT) symptoms were associated with non-acid reflux. These results were similar to a Multicenter MII-pH studies in patients with PPI refractory symptoms in which suggested that approximately one third of patients to have weakly acid or nonacid reflux.2,3 The problem of MII-pH on PPI therapy may be the limited number of reflux event associated with symptoms. Fifty-two percent (37/71) patients did not report any symptoms during the impedance pH study. In my opinion, the limitation of the study, as the authors had mentioned in the text, was that the patients' groups were inhomogeneous regarding medication use and predominant symptoms. It could have an influence on the diagnostic sensitivity and clinical impact of esophageal impedance pH monitoring. In those who fail on PPI once a day, there are 2 major potential therapeutic strategies that are utilized in clinical practice - switching to another PPI or doubling the dose of the same PPI. Doubling the PPI dose is by far the most common therapeutic strategy used by practicing physicians. In this study, 59% of patients were refractory to single dose of PPI. In those patients the MII-pH may be the next step after doubling the PPI dose in the diagnostic algorithm. In addition, to obtain the therapeutic response, patients reporting extraesophageal manifestation usually require more than the standard dose of PPI.4 The second question is about the role of impedance in patients with atypical symptoms while on PPI. As many experts have indicated, those in whom GERD is more likely (typical symptoms) should be considered for impedance pH testing while on therapy because testing in those patients is more likely to reveal ongoing reflux (either acid or nonacid) despite the medication. In contrast, patients in whom GERD is less likely (atypical presentation) may be best served by pH monitoring while off medication.5 A negative test in those patients while off therapy directs the diagnostic work up toward other causes, and it enables cessation of unnecessary PPI therapy. Choosing patients based on their clinical presentation may be helpful. ENT symptoms are widely accepted as it is unlikely to be related with acid. Therefore, in those patients, impedance pH monitoring while off medication could give more clinical information. Further studies with large cases are needed to solve the limitations of the present study and to evaluate to whom clinical impact of impedance pH would be more.

Ear, nose and throat involvement in patients with pemphigus vulgaris: correlation with severity, phenotype and disease activity

Pemphigus vulgaris (PV) is the most common clinical form of pemphigus that is characterized by easily ruptured or loose bulla formation on skin and/or mucosa. The frequency of the ear, nose and throat involvement of PV is not clearly defined. To evaluate the frequency of ear, nose and throat (ENT) involvement in patients suffering from PV who had been recently diagnosed or exacerbated under follow up and to determine the association with ENT symptoms, clinical involvement, severity and duration of pemphigus vulgaris. The study group included a total of 38 PV patients comprising 24 new patients and 14 patients who showed exacerbations while on complete remission or under treatment. All patients were asked about ENT symptoms and endoscopic examination were performed to evaluate the presence of nasal, pharynx, larynx and ear involvement. Of the 38 patients, 33 (87%) had active PV lesions on endoscopic evaluation. Twenty-five patients (66%) had lesions on pharynx, twenty-one (55%) on larynx, twenty-nine (76%) on nasal mucosa and four (10%) on the ear mucosa. ENT involvement was not associated with the severity and the clinical involvement of the disease. Pharyngeal and nasal involvement was significantly associated with symptoms, while laryngeal and ear involvement was not found to be significantly associated with symptoms. Nasal and ear involvement was not associated with the duration of the disease while pharyngeal and laryngeal involvement favored newly diagnosed patients. Our results revealed that high number of patients with PV may present with active ENT lesions, furthermore patients with ear, nose and throat involvement may be asymptomatic and active lesions may be found in patients without any ENT symptoms. Therefore it should be considered that to understand the real extent of PV involvement, endoscopic ENT evaluation should be performed in patients with or without symptoms.

The prevalence of ear, nose and throat problems in the community: results from a national cross-sectional postal survey in Scotland

To assess the prevalence of ear, nose and throat (ENT) symptoms experienced by individuals living in Scotland, and their use of GP or hospital services for these problems. A cross-sectional postal self-completed questionnaire was sent to a random sample of 12,100 households throughout Scotland. 15,788 individuals aged 14+ years living in the 7244 households who returned the questionnaire (adjusted response rate 64.2%) participated in the study. Roughly a fifth of respondents reported currently having hearing difficulties, including difficulty following conversations when there is background noise and hearing problems causing worry or upset; few wore a hearing aid regularly. A fifth reported noises in head or ears (tinnitus) lasting more than five minutes. In the previous year, between 13 and 18% of respondents reported persistent nasal symptoms or hayfever, 7% sneezing or voice problems and 31% had at least one episode of severe sore throat or tonsillitis. Nearly 21% of all respondents reported ever having had dizziness in which things seemed to spin around the individual; 29% unsteadiness, light-headedness or feeling faint; 13% dizziness in which the respondent seemed to move. Important gender, age, occupation and deprivation differences existed in the occurrence of these ENT symptoms. There was considerable variation in the proportion of individuals consulting their GP or being referred to hospital for different problems. ENT problems occur frequently in the community, and most are managed without consulting medical services. Whilst reasonable for many problems, there are likely to be important groups in the community with ENT problems that might benefit from modern interventions.

Determinants of compliance with an early detection programme for cancer of the head and neck in north-eastern Italy.

An early detection programme for cancer of the head and neck (H&N) has been conducted from January 1991 to January 1993 in Pordenone province, north-eastern Italy, an area with very high mortality rates for cancers in those sites. 627 high-risk individuals (491 males, median age 57 years and 136 females, median age 47 years) (i.e. smokers and/or drinkers of more than a half litre of wine or equivalent per day) were referred to a research nurse by 21 general practitioners. An educational message on the health hazards of tobacco and alcohol abuse was delivered together with an invitation to undergo a free ear, nose and throat (ENT) examination at a nearby hospital. 212 individuals (34%) underwent the ENT visit. The influence of various individuals' characteristics on the lack of compliance was assessed. Female sex and absence of ENT symptoms were associated with a more than two-fold higher lack of compliance. Current smokers were more than three-fold less likely to accept the invitation to undergo the examination. Conversely, alcohol intake and, within smokers, the amount smoked seemed unimportant. This study shows that the correct identification of high-risk individuals is expensive and the compliance with a H&N cancer early detection programme relatively low, especially among smokers.