A suitable test for identifying high risk adult patients of moderate-severe obstructive sleep apnea syndrome.

The aim of this study was the evaluation of the usefulness of a 7-items questionnaire, Rome Questionnaire (RQ), in identifying adult patients at risk of obstructive sleep apnoea syndrome (OSAS). 136 adults (76 M, 60 F) with snoring were enrolled. Each patient underwent to an overnight polysomnography (PSG) study and the patient's bed partner answered the "RQ". RQ survey items mainly addressed the presence and frequency of snoring behaviour, breathing pauses, sore throat, oral breathing and wake time sleepiness. Of the 136 initial patients, 111 (63 M, 48 F; mean age 54.6 +/- 10.84) with a complete PSG examination were included in the study. They were divided according to apnea-hypopnea index (AHI) into two groups: group A with a primary snoring or mild OSAS (AHI < or = 15) and group B with moderate-severe OSAS (AHI > 15). The RQ final score was 25.27 +/- 16.1 for group A and 42.29 +/- 15.2 for group B, with a statistically significant (p < 0.0001) difference. Analyzing the RQ score of group B (moderate-severe OSAS) we surprisingly noticed that most of patients (66%) showed an high RQ score (> 40). No patients with moderate-severe OSAS showed a RQ score < 20 and for every point scored in the questionnaire there is an extra 1.07 (0.7%) risk of belonging to group B. Group B showed a mean body mass index (BMI) of 31.53 (+/- 4.95), significantly (p < 0.001) higher than BMI of group A (26,86 +/- 3.28) and BMI results a good predictive factor (p = 0.013) of mild-severe OSAS. In conclusion, the "RQ", together with BMI, seems to be an useful tool to make a selection of the patients at higher risk of moderate-severe OSAS, who need a prompt PSG evaluation. Our findings will require further validation in larger sample of subjects.

Nasal surgery and eustachian tube function: effects on middle ear ventilation.

OBJECTIVES: To investigate the effect of nasal obstruction surgery on eustachian tube function and middle ear ventilation. DESIGN: Prospective study. SETTING: University Campus Bio-Medico of Rome. PARTICIPANTS: Forty consecutive patients who underwent nasal surgery were evaluated for middle ear ventilation and tubal function. MAIN OUTCOME MEASURES: Pre- and postoperative Valsalva and Toynbee tubal function tests, tympanometry and ear fullness sensation were evaluated for both ears of each patient. RESULTS: Results of postoperative tubal function tests were significantly better than preoperative ones (90% versus 46%; P<0.001). No significant difference in tympanometric values was found. The majority (95%) of the patients reported a postoperative improvement of ear fullness sensation compared with preoperative (25%; P<0.001). CONCLUSIONS: Surgery for chronic nasal obstruction significantly improves clinical tubal function but 1-month postoperative tympanometric findings remain almost the same.

[Peripheral facial palsy in middle ear surgery: case report and review of literature]. / La paresi periferica del facciale nella chirurgia dell'orecchio medio: caso clinico e revisione della letteratura.

We present a case of a patient who experienced right facial palsy after being operated for otosclerosis. Seventeen years before our patient had yet undergone the same operation on the contralateral ear and had presented a facial palsy. We also report another case of facial palsy and middle ear damage after an operation for otosclerosis. Facial palsy is a rare complication of middle ear surgery. It is probably caused by a viral relapse and it recedes after few weeks if a proper therapy is administrated to the patient. Thus we deem it is useless to perform immediately advanced, invasive and expensive tests. On the contrary we believe that it is useful, in those cases in which an otosclerotic patient has a history of herpes simplex virus infection, to administer a preventive antiviral therapy before the operation.

Hearing thresholds in patients affected by rheumatoid arthritis.

The aim of the study was to evaluate hearing thresholds in 38 patients with rheumatoid arthritis, divided according to disease activity into active (group A, n = 20) and non-active (group B, n = 18) patients. Pure tone audiometry, tympanometry and complete rheumatological assessment were performed. All patients presented poorer auditory thresholds compared with controls. Patients of group A had both air and bone conduction thresholds poorer than group B (although not statistically significant), and most patients of both groups presented an air-bone (a-b) gap. No significant difference in middle ear pressure was noticed between patients and controls. No correlation between hearing impairment and duration of the disease or patients' age was found. The high prevalence of hearing loss in autoimmune diseases supports the importance of audiometric evaluation in such patients. The auditory recovery through middle ear surgery before cranial nerve involvement could be considered in selected patients. Further investigations are needed for a better knowledge of the middle and inner ear involvement in patients with rheumatoid arthritis.

Stapes surgery in relation to age.

This prospective study aims to evaluate the efficacy of stapedotomy in relation to age. Eighty-four ears of 82 consecutive patients who underwent stapedotomy were studied. Patients were divided into five groups according to their age. In each patient, we evaluated the pre- and postoperative auditory thresholds, according to the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology - Head and Neck Surgery guidelines. Statistically significant (P < 0.05) differences between the pre- and postoperative air conduction thresholds were observed in all groups. Statistically significant reductions of air-bone gap were observed at lower-medium frequencies (250, 500 and 1000 Hz) in the elderly as well as in the younger patients. We did not find a higher susceptibility of the inner ear to surgical trauma in the elderly in comparison to the younger patients. Our data show that stapedotomy results in older adults are comparable to those obtained in the younger, without an increased incidence of complications.

Bilateral irreversible hearing loss associated with the combination of carboplatin and paclitaxel chemotherapy: a unusual side effect.

The regimen with paclitaxel and platinum compound (carboplatin or cisplatin) is the standard chemotherapy for patients with advanced ovarian cancer. Ototoxity for carboplatin and paclitaxel alone or combined is rarely observed. We report the case of a 35-year old female with advanced ovarian cancer who developed sudden bilateral sensorineural hearing loss related to paclitaxel and carboplatin based chemotherapy. This uncommon adverse effect of carboplatin and paclitaxel alone or combined is discussed and the literature reviewed. Hearing monitoring should be mandatory to evaluate the real incidence of clinical and sub-clinical hearing modification induced by carboplatin and paclitaxel based chemotherapy.

Nerve growth factor serum level is reduced in patients with sensorineural hearing impairment: possible clinical implications.

Nerve growth factor (NGF) is the first and best characterised member of a family of neurotrophic factor. NGF is produced by numerous cells and it is present in physiologically relevant amounts in the bloodstream. It is known to promote the survival of peripheral sensory neurons and can be potentially useful as a therapeutic agent in neuronal system. On the both these observations we based our hypothesis that low circulating NGF might lead to sensorineural hearing loss (SNHL). To address this question we measured the levels of NGF in the bloodstream of patients affected by SNHL. The results showed that the amount of circulating NGF in these patients is significantly lower compared to levels found in patients not affected by this deficit. The results of the present study demonstrated that NGF might be a useful candidate for preventing the damage and promoting recovery or degeneration of the auditory pathways in humans.