Sleep apnoea/hypopnoea syndrome: combination therapy with the Pillar palatal implant technique and continuous positive airway pressure (CPAP). A preliminary report.

A preliminary report. The objective of this study was to evaluate the possibility of reducing CPAP pressure levels and improving patient adherence to CPAP therapy by stiffening the soft palate tissue with a Pillar palatal implant. Many patients have difficulty complying with CPAP therapy if high levels of airway pressure are necessary for their therapy to be successful. Twenty-one patients (16 males and 5 females) with moderate to severe OSAHS treated with CPAP therapy underwent Pillar palatal treatment in an office-based procedure. The mean age was 49.6 +/- 11.2 years, mean baseline body mass index (BMI) was 31.4 +/- 3.2 Kg/m2. At 3 months follow-up a significant reduction of CPAP pressure levels was found. Mean CPAP pressure levels before and after Pillar application were 11.2 +/- 1.69 cm H2O vs. 9.3 +/- 2.5 cm H2O respectively (p < 0.001). The Pillar system is intended for use in stiffening the soft palate tissue, so this minimally invasive procedure, which was introduced to clinical practice as a treatment for the palatal component of OSAHS, could make it possible to reduce CPAP pressures and improve patient adherence to CPAP therapy. The preliminary results of this combined therapeutic approach indicate the safety and efficacy of the treatment of OSAHS. Further studies are needed to evaluate the long-term results.

Endoscopic transnasal surgical approach for monolateral myopic non-Graves' exophthalmos: a case report.

Transnasal endoscopic orbital decompression is emerging as a new minimally invasive technique that avoids the need for cutaneous or gingival incision. This surgical approach appears to be a safe and effective procedure, even for the treatment of ocular disease, and it can be performed under general or local anaesthesia. The authors present a case of severe monolateral non-Graves' axial exophthalmos, accompanied by severe anisometropic myopia, which was treated successfully with functional endoscopic sinus surgery. The minimally invasive surgical procedure resulted in a marked reduction of exophthalmos without any severe complications and with minimal discomfort for the patient, who was discharged from hospital on the fourth postoperative day.

Laryngeal paraganglioma: an endoscopic diode-laser-assisted surgical approach: a case report.

Laryngeal paraganglioma is a rare vascular neuroendocrine benign tumour. Surgery is the standard treatment. The pre-operative gold standard is Magnetic Resonance Imaging with Gadolinum contrast. Computed tomography scans and angiography are also useful in making the diagnosis of paraganglioma before surgical intervention. A case of a large supraglottic paraganglioma is described. Complete excision of the tumour was achieved using microlaryngoscopical-laser surgical resection. No severe complications were observed. The patient was discharged from hospital without any complaints on the fourth post-operative day and she was disease-free 36 months after surgery. The effectiveness of this conservative endoscopic surgical procedure compared to the external approaches is discussed and it can be concluded that the endoscopic diode-laser resection of even extended laryngeal paraganglioma provides a good operative field and is a safe and effective technique.

Giant osteoid osteoma of ethmoid sinus: role of functional endoscopic sinus surgery.

A case of giant ethmoid osteoma treated by functional endoscopic sinus surgery is described. The tumour was closely adherent to the surrounding anatomical structures--lamina papyracea, cribriform plate, spheno-ethmoidal recess--and protruded into the nasopharynx. Complete removal of the tumour, under general anaesthesia, using intranasal drill and diode L.A.S.E.R, was achieved. The principal aspects in favour of this surgical technique vs. open procedures (fronto-basal craniotomy, supraciliar and coronal approach) are discussed. Functional endoscopic sinus surgery is herewith concluded to be a convenient and safe technique with advantages over the open procedures, widely used in the past. The reduced morbidity, length of hospital stay and better cosmetic results are distinct advantages of this technique that has the potential to become the treatment of choice for selected ethmoid tumours, such as giant osteoma, described in the present report.

[Products of acoustic distortion in the examination of deafness in an infant]. / Les produits de distorsion acoustique dans le dépistage de la surdité du jeune enfant.

Distortion-product otoacoustic emissions (DPOAEs) are otoacoustic emissions evoked by two pure tones. The greatest advantage of DPOAEs is their frequency specificity with respect to the eliciting bitonal stimuli. The purpose of this study was to compare DPOAEs in two populations. This paper reports input/output DPOAEs functions and DPOAE-audiograms for audiometric frequencies of f2 between 696 and 6006 Hz in a normal neonate population and in an adult control group. Fifteen healthy fullterm newborns (29 ears) and 8 normal-hearing adults (16 ears) participated as subjects. Results at medium frequencies indicate that the maximum amplitudes of the DPOAEs were generated by neonates, the detection threshold was better and the dynamic range was greater than in adults, making them potentially valid for studying cochlear functioning in infants.

[Otoacoustic distortion products in adults with normal hearing]. / I prodotti di distorsione otoacustici nei soggetti adulti normoacusici.

Distortion Product Otoacoustic Emissions (DPOEs) are otoacoustic emissions evoked by two pure equilevel tones (f1, f2) called primaries and are believed to provide frequency-specific information regarding cochlear function. We recorded DPOEs at 2f1-f2 frequency with a constant frequency ration (f2/f1 = 1.22) in 8 normal hearing subjects (16 ears, mean age 28 +/- 1.5) to establish the characteristics of these emissions in the adult population. DPOEs were measured at the following F2 frequencies and respective fp geometric mean frequencies: 696/632, 1001/904, 1501/1360, 2002/1809, 3003/2714, 4004/3626, 5005/4531 e 6006/5435 Hz. Detailed testing included the recording of DPOE "audiograms" and input-output functions depicting the relationship of the amplitudes of DPOE to primary-tone levels ranging from 25 to 70 dB SPL in 5 dB steps. The present findings are in good agreement with investigations based on evoked otoacoustic emissions published by other researchers. The average DPOE "audiograms" demonstrated a low-frequency maximum at 1501 Hz (f2)/1360 (fp) and a high-frequency peak at 5005 Hz (f2)/4531 (fp). The two maximum regions were separated by a minimum around 3003 Hz (f2)/2714 (fp). This study confirms the feasibility of DPOE measurements among adults and provide a normal baseline for this age group. DPOEs could be useful, in association with evoked otoacoustic emissions and with auditory brainstem responses, in obtaining a precise evaluation of the peripheral auditory system.

[Short-term reproducibility of acoustic oto-emissions induced by clicks in adults]. / Reproductibilité à court terme des oto-émissions acoustiques provoquées par des clics chez des sujets adultes.

Otoacoustic emissions (OAE) are sounds emitted by the cochlea and recordable in the external ear canal by a miniature microphone. The OAE reflect the existence of an active mechanism within the cochlea. Development of the OAE has spurred much interest because they may used as a valid test for screening and monitoring cochlear changes. The OAE were recorded in 8 normal hearing subjects (15 ears) during nine test sessions under similar conditions. The aim of this work was to study the short-term variability in the amplitude of the emissions. Results of the study indicate that response levels are stable over time in the same ear therefore changes in the response level can be associated with changes in the cochlea.

[Evoked oto-acoustic potentials in the first 60 hours of life]. / Les otoémissions acoustiques évoquées pendant les 60 premières heures de vie.

In order to verify how age influences in the first days of life the presence of Evoked Otoacoustic Emissions (EOAE), the authors tested 52 newborns. They conclude that EOAE is a reliable technique as an early detection test of hearing loss in children. However, a high percentage of false positive cases during the very first days of life advises against its too early utilization.

[Bacteriology of chronic maxillary sinusitis]. / Zur Bakteriologie der chronischen Sinusitis maxillaris.

132 patients with chronic maxillary sinusitis were included in this bacteriological study of the intrasinus exudate obtained by a radical antrostomy or antral puncture. We found 78.3% aerobes, 21.7% anaerobes, 51.5% gram positive and 48.5% gram negative micro-organisms, but no fungi in 120 cultures. The commonest aerobic species was Haemophylus (20%), whereas Peptococcus and Bacteroides were the commonest anaerobes (10%).

[Evoked oto-acoustic emissions (EOE) as screening method in infants]. / Die evozierten otoakustischen Emissionen (EOE) als pädaudiologische Screeningmethode.

The authors consider the problems of the early diagnosis of paediatric hypoacusis, presenting a study done on twenty audiological high risk children that were subjected to audiometric screening by delayed cochlear otoacoustic emissions (EOE) and brainstem auditory evoked potentials (BEAPs). Eighteen of twenty children that were examined were normal, while two had bilateral sensorineural hearing loss. EOE were evoked in all patients that presented normal BAEP thresholds, while they were absent in deaf subjects. Evoked otoacoustic emissions research allows us to identify two groups of subjects: those with normal EOE who can be considered normal hearing subjects, and those without EOE who may present a disturbed auditory system. Nevertheless, EOE testing does not allow us to judge the type of hearing loss. The time for EOE testing is approximately five minutes for each subject. On the grounds of their experience, the authors conclude that EOE testing represents a useful and reliable test which differentiates normal auditory function subjects from hypoacoustic ones. Compared to other techniques used in audiological paediatric diagnosis, such as reactometry, BOEL test and Crib. O. Gram, which present the possibility of false positive and false negative results, and BSERA, which even if reliable, must be limited to few selected audiological high-risk subjects, EOE is easy to implement and readily available. Major limitations of this technique seem to be the possibility of false positives, and the impossibility to specify localisation and type of the hearing loss by EOE only.

[Submaxillary gland excisions: a retrospective investigation]. / Sialectomies sous-maxillaires: enquête rétrospective.

Swellings of the submaxillary region are very frequent in otorhinolaryngology clinical practice. The authors of this study analyzed 106 cases of submaxillary gland excision under their observation, emphasizing their epidemiological, clinical and anatomopathological aspects which could be useful during the diagnostic and therapeutic phase of the submaxillary gland affections. They also made a comparison with the data already published on the same subject.