The cochlear implant programme in Crete: a nine year experience.

The aim of this study was to present data of the cochlear implant programme in Crete. Our series consists of 51 patients, 35 adults and 16 children, in a nine year period. The average age of our patients was 31 years (range from three to 68). The average duration of deafness among our patients was seven years (range from two to 22). Our series included 32 postlingual patients and 19 prelingual patients. The cause of deafness in our series was unknown in approximately 40 per cent of cases. Standard selection criteria and operative techniques were used for all cases. Postoperative programming and rehabilitation were performed according to the individual needs of each patient. Implantation was successful in all patients except one who had to undergo a second operation with good results. No major postoperative complications were noted, while minor complications included temporary facial weakness and undesired stimulation of the facial nerve during implant function in two and three patients, respectively. All patients showed significant improvement in perception and discrimination of sound and speech. Better results have been noted in prelingual patients under the age of six, as well as in postlingual adults with a recent history of deafness. As cochlear implant technology evolves and surgical techniques continue to improve, our department will continue its efforts to provide effective hearing rehabilitation of deaf children and adults in Crete.

Epiglottis reshaping using CO2 laser: a minimally invasive technique and its potent applications.

Laryngomalacia (LRM), is the most common laryngeal abnormality of the newborn, caused by a long curled epiglottis, which prolapses posteriorly. Epiglottis prolapse during inspiration (acquired laryngomalacia) is an unusual cause of airway obstruction and a rare cause of obstructive sleep apnea syndrome (OSAS). We present a minimally invasive technique where epiglottis on cadaveric larynx specimens was treated with CO2 laser. The cartilage reshaping effect induced by laser irradiation was capable of exposing the glottis opening widely. This technique could be used in selected cases of LRM and OSAS due to epiglottis prolapse as an alternative, less morbid approach.

Septal cartilage reshaping with the use of an Erbium doped glass fiber laser. Preliminary results.

STATEMENT OF PROBLEM: To evaluate the efficacy of Erbium doped glass fiber laser in patients undergoing nasal septal cartilage reshaping. METHOD OF STUDY: A prospective study was conducted in patients undergoing laser nasal septal cartilage reshaping. Microsurgical sponges soaked in a tetracaine solution plus adrenaline were applied in each side of the nose for ten minutes before the procedure. The cartilage of nasal septum was straightened and fixed in the median position using a modified nasal speculum. An optothermomechanical contactor with transparent indenter and thermocouple sensor was placed on septal regions of maximum mechanical stress. Patients were asked to evaluate the severity of pain during the procedure on a visual analog scale. A rhinomanometric evaluation was conducted preoperatively and postoperatively. All patients were asked to evaluate the improvement of their symptoms. All patients' data and potential complications were entered in a database and were statistically assessed. MAIN RESULTS: Our series consisted of 64 patients. Statistical analysis showed significant improvement of their symptoms and of rhinomanometric results. No complications or side effects occurred. The mean operative time was 35 minutes. PRINCIPAL CONCLUSION: Septal cartilage reshaping is an easy painless and bloodless method using en Erbium doped glass fiber Laser. Laser device LSC-701 (Arcuo Medical Inc.) is effective, safe and inexpensive medical equipment.

Langerhans cell histiocytosis presented as bilateral otitis media and mastoiditis.

Langerhans cell histiocytosis (LCH) is a rare disease that may affect multiple organs. The etiology of LCH remains unclear to date. It is currently believed that clonal accumulation and proliferation of CD1a-positive Langerhans cells are causative. The term LCH or histiocytosis X refers to three separate illnesses (listed in order of increasing severity): eosinophilic granuloma, Hand-Schüller-Christian disease and Letterer-Siwe disease. A seven-month-old boy presented with history of recurrent bilateral otitis media and rash and seborrheic areas on his scalp. Two days prior, his mother noticed a small lump over the right mastoid. Lateral skull X-ray (Schüller) was evidence for lytic lesion on right temporal bone. The computerized tomography scan showed inflammatory changes with bone erosion. During surgical exploration, fragile slightly yellowish tissue with necrotic areas was found that was determined as LCH on histology. Chemotherapy was subsequently initiated. The initial presentation of LCH with bilateral ear and skull involvement is a very rare condition. The signs and symptoms of otologic histiocytosis can mimic those of acute and chronic infectious ear disease. Only a surgically obtained biopsy leads to definitive diagnosis and appropriate therapy.

Antihistamine effects on experimental middle ear inflammatory model.

Allergy is thought to be one of the etiologic factors in otitis media. The purpose of this study was to determine the histopathologic effects of H1 histamine receptor antagonists in an experimental histamine-induced middle ear inflammation model. In group A (20 rabbits), histamine challenge followed a 3-day intramuscular pretreatment with a single dose of 0.1 ml hydroxyzine hydrochloride (50 mg/ml) per day. In group B (20 rabbits), histamine challenge followed a 3-day pretreatment with a single dose 1.2 mg desloratadine per day orally. In group C (20 rabbits), histamine challenge followed a 3-day pretreatment with a single dose 1.2 mg levocetirizine per day orally. On the fourth day after baseline otomicroscopy 0.5 ml histamine 20 mg/ml was injected transtympanically on the right. Middle ear mucosa was removed and the following parameters were assessed: edema, vascular dilatation and congestion, inflammation, acute inflammatory component, presence of eosinophils, activity of the inflammation and fibrosis. A semi-quantitative grading system of 0-3 was used for grading of all parameters and statistical analysis performed by using the Mann-Whitney non-parametric test. Group A mucosae showed lower grades of all the parameters evaluated compared with those of group B. Histopathology of the mucosae of group C showed lower grade of inflammation compared with group B with significant statistical difference for the seven parameters tested. Our data validate the use of antihistamines in the treatment of refractory OME of allergic origin. Oldest H1 antagonists can be replaced by the newest agents who counteract successfully histamine effects, without any interactions or adverse effects from central nervous system.

Assessment for microsatellite DNA instability in nasal cytology samples of patients with allergic rhinitis.

BACKGROUND: Genetic alterations, including microsatellite instability (MSI) and loss of heterozygosity (LOH), have been described in both malignant and benign diseases. Previous studies have successfully detected such alterations in sputum samples of patients with bronchial asthma (BA). The aim of this study was to assess the presence of MSI and/or LOH in nasal cytology samples of patients with allergic rhinitis (AR). METHODS: Nasal brush samples and peripheral blood from 20 patients with AR were analyzed. DNA was extracted and analyzed for MSI and LOH using the following microsatellite markers: D16S289, D4S2394, D4S1651, DXS8039, D3S3606, and D2S2113, harboring potential susceptibility genes for AR and atopy. Microsatellite analysis was performed also in eight control subjects. RESULTS: No MSI and/or LOH were noted in either the AR or the control group. CONCLUSION: Although MSI and LOH are detectable phenomena in sputum samples of patients with BA, this seems not to be the case for nasal cytology samples of patients with AR. Additional studies are needed, using a larger number of polymorphic markers, to assess if such a difference exists among two diseases otherwise very closely related.

Microsatellite DNA instability in nasal cytology of COPD patients.

Genetic alterations in the microsatellite DNA level have been successfully detected in sputum samples of patients with COPD and have been shown to be disease specific. Furthermore, previous studies have shown that inflammation coexists in the nasal mucosa of patients with COPD. The aim of this study was to assess the presence of MSI in nasal cytological samples of patients with COPD comparing the results with sputum samples of the same individuals. Nasal brush samples, sputum samples obtained by induction, and peripheral blood from 20 patients with COPD were analyzed. DNA was extracted and analyzed for MSI using the following microsatellite markers: RH70958, D5S207, D6S344, D6S263, G29802, D13S71, D14S588, D14S292 and D17S250. Microsatellite analysis was also performed in 8 healthy non-smokers. MSI was detected in the sputum samples of 7 patients with COPD (35%). In contrast, no microsatellite DNA instability was noted in the nasal cytological samples of the same COPD patients. In addition, no genetic alteration was detected in the control group. These results suggest that MSI is a specific finding for the target organ of COPD, i.e. the lungs, despite the fact that inflammation coexists in the nasal mucosa of COPD patients. Our study supports the hypothesis that MSI could be an index of the somatic-acquired genetic alterations in the lungs of COPD patients.

In vitro enzymatic treatment and carbon dioxide laser beam irradiation of morphologic cartilage specimens.

OBJECTIVES: To determine the role of the main cartilage components in the internal system of interlocked stresses and to clarify the effect of laser beam irradiation on cartilage. DESIGN: Control and experimental series. SUBJECTS: Rabbit ear cartilage. INTERVENTION: Rabbit ear cartilage strips incubated in collagenase and hyaluronidase enzyme solutions for specific periods were examined, and the observed changes in shape, strength, and elasticity were recorded, as well as the effect of carbon dioxide laser irradiation. Laser-pretreated cartilage strips were also incubated in the enzyme solutions to determine whether the laser-provoked changes were susceptible to enzymatic action. All cartilage pieces were examined by light and electron microscopy. RESULTS: Collagenase-treated cartilage strips gradually lost their interlocked stresses, while hyaluronidase-treated strips mostly maintained their shape and their physical characteristics. Hyaluronidase-incubated cartilage strips altered their shape when they were laser treated. Collagenase-treated cartilages did not modify their shape when they were laser treated. Laser-pretreated cartilage pieces lost their new form in collagenase solutions but kept their laser-evoked shape when put in hyaluronidase solutions. CONCLUSION: The macroscopic observations combined with light and electron microscopy findings argue for the distinct role of the collagen network in morphologic cartilage shape and tensile strength preservation and provide a probable mechanism of cartilage transformation owing to carbon dioxide laser irradiation.

Osteoid osteoma of the ethmoid bone associated with dacryocystitis.

BACKGROUND: Osteoid osteomas (OO) are small, benign osteoblastic lesions. Ethmoid bone OO has been very rarely reported so far. CASE PRESENTATION: We report a case of a 16-year-old boy suffering from persistent epiphora and a mild pain in the area of median canthus, due to a bone density mass within the right ethmoid air cells extending to the ipsilateral right orbit. The mass was removed via an external ethmoidectomy approach. Histopathologic examination of the specimen set the diagnosis of OO. One year after the operation the patient is free of symptoms, while no recurrence occurred. CONCLUSION: A case of ethmoid bone OO associated with dacryocystitis is reported. Although benign and rare, OO should be considered in differential diagnosis of the ethmoid bone osteoblastic lesions.

Canal wall down mastoidectomy for cholesteatoma: experience at the University of Crete.

OBJECTIVE: To evaluate clinical and audiologic data as well as operative findings and postoperative follow-up in the management of chronic cholesteatomatous otitis media with canal wall down mastoidectomy (CWDM). STUDY DESIGN: A retrospective review of cases followed up between 1990 and 2002. SETTING: Tertiary referral centre. METHOD: Two hundred one patients with chronic otitis media with cholesteatoma underwent CWDM. MAIN OUTCOME MEASURES: Clinical presentation, surgical findings, and audiologic evaluation were assessed. RESULTS: Preoperatively, eight patients suffered from vertigo and four presented with facial nerve paralysis. In 40 patients (20%), erosion of the lateral semicircular canal was found, and in 31 patients (15%), there was dehiscence of the facial nerve canal. Dural plate erosion and sinus plate dehiscence were found in 13 and 17 patients, respectively. Nine patients experienced serious endocranial complications at their admission. The malleus was noted to be intact in the majority of patients in all age groups. The incus was eroded or absent in most of the cases in all age groups. On postoperative evaluation 3 months after surgery, 195 audiograms were performed, with a mean pure-tone average of 55 dB HL and a mean air-bone gap of 30 dB HL. CONCLUSION: Although CWDM has the disadvantages of the necessity to avoid water insertion in the external auditory canal and lifelong mastoid care, it is an effective treatment in a single-step procedure for patients with advanced disease and for those who refuse to submit to postoperative follow-up.

Gingival condition of women with gestational diabetes on a Greek island.

The purpose of this study was to investigate the condition of gingival tissues in women who had gestational diabetes mellitus. The study group consisted of 64 women with gestational diabetes and the control group of 88 healthy pregnant women. The plaque index and gingival index and their relationship to a series of variables (socio-demographic, diet, oral hygiene, oral condition) were evaluated. Clinical evaluations were carried out between 34 and 36 weeks of pregnancy. The women with gestational diabetes had a higher mean plaque index and higher mean gingival index than the healthy pregnant women (p = 0.048 and p = 0.029, respectively). Linear regression analysis showed an association between gingival index and plaque index (p < 0.001). Gestational diabetes was not significantly related to gingivitis when other factors that differed between the two groups were taken into account. The results of the study suggest that gingival inflammation seems to be more prevalent in women with gestational diabetes compared to healthy pregnant women, while the plaque accumulation remains the main cause of gingival inflammation.

The use of the Ligasure Vessel Sealing System in parotid gland surgery.

OBJECTIVE: To evaluate the role of the Ligasuretrade mark Vessel Sealing System (LVSS; Valleylab, Boulder, CO) in parotid surgery. STUDY DESIGN: A prospective study was conducted on 12 consecutive patients undergoing superficial parotidectomy, performed by using the LVSS device as the primary means of ligation. Inclusion criteria included parotid mass with no preoperative suspicion of malignancy, and no extension to the deep lobe of the parotid gland. Efficacy of hemostasis, cut-closure time, and postoperative complications were assessed. Results were compared with a historical control group, including cases on which the LVSS was not available. RESULTS: LVSS proved effective in providing ligation and hemostasis. There was a mean time gain of 52 minutes, compared with our historical control group. No postoperative bleeding, seroma, salivary fistula, or Frey syndrome were observed. One case of transient facial weakness occurred, which was completely resolved within 6 months. CONCLUSION: LVSS is a safe device for parotid gland surgery, providing sufficient hemostasis and reducing operative time. EBM RATING: B-2.

Laser-assisted tympanostomy in pediatric patients with serous otitis media.

OBJECTIVES: To evaluate prognostic factors related with cure rate, in pediatric patients with serous otitis media treated with laser-assisted tympanostomy without ventilation tubes, in a single institution. PATIENTS AND METHOD: The procedure was performed on 124 ears in 88 individuals, from 3 to 14 years old. External auditory canal anatomy, type of anesthesia, tympanic membrane and middle ear fluid characteristics, myringotomy size, and laser parameters, in relation to cure rate, were accordingly studied. RESULTS: The overall cure rate by ear at the end of the 2-month follow-up period was 54.83%, whereas 45.17% still suffered from otitis media. Multivariate statistical analysis demonstrated that the presence of a thick tympanic membrane is significantly correlated with pure outcome in children with serous otitis media, when laser-assisted tympanostomy without ventilation tubes is performed favoring a worse cure rate (P < 0.023). Other parameters did not statistically correlate with the outcome. A 41% parental dissatisfaction rate was noticed. CONCLUSION: This study addresses selection bias for children with serous otitis media, candidates for laser-assisted tympanostomy. These are related to the duration of serous otitis media, the condition of middle ear mucosa, the thickness of the tympanic membrane, the type of anesthesia, and the cost of laser apparatus. There is likely to be a causal relationship between outcome and tympanic membrane appearance in children undergoing laser-assisted tympanostomy.

Ligasure versus cold knife tonsillectomy.

OBJECTIVE: To assess parameters related to ligasure tonsillectomy (LT) versus cold knife tonsillectomy (CKT) procedure. STUDY DESIGN: Prospective randomized study. METHODS: A prospective study was conducted on 200 consecutive adult patients undergoing tonsillectomy. Indications included chronic tonsillitis and obstructive sleep apnea syndrome. Patients undergoing adenoidectomy, or any procedure together with tonsillectomy, and patients with peritonsillar abscess history or bleeding disorders were excluded. Patients were randomly assigned to either the LT or CKT group. Intraoperative bleeding, operative time, postoperative pain using a visual analogue scale, and complication rates were evaluated. RESULTS: The LT and CDT groups consisted of 108 and 92 individuals, respectively. In the LT group, there was no measurable intraoperative bleeding, whereas mean bleeding for CKT group was 125 mL. The mean operative time was 15 +/- 1.43 minutes for the LT group and 21 +/- 1.09 minutes for the CKT group (P < .001). The overall mean pain score for the LT group was 3.63, whereas for the CKT group it was 5.09 (P < .001). Primary hemorrhage occurred in one subject of the CKT group. Secondary postoperative hemorrhage was noticed two subjects of the LT group and two subjects of the CKT group. In 21 subjects of the LT group, limited peritonsillar edema was noticed. No other complication occurred in both groups. CONCLUSION: LT procedure provides sufficient hemostasis, lower postoperative pain, and reduced operative time, as well as safety against Creutzfeld Jakob disease transmission.

Benign paroxysmal positional vertigo: 10-year experience in treating 592 patients with canalith repositioning procedure.

OBJECTIVE: To assess the long-term efficacy of canalith repositioning procedure (CRP) in the treatment of patients with benign paroxysmal positional vertigo (BPPV). BACKGROUND: Alternative theories for the pathophysiology of BPPV have been redefined in the past few years. CRP is considered to be the standard technique for its management. However, long-term follow-up results have been minimally reported in the literature. PATIENTS/METHODS: Five hundred ninety-two patients, 290 (49%) men and 302 (51%) women, were enrolled in this prospective study; their ages ranged from 18 to 84 (mean 59) years. At the time of their first examination, patients reported the duration of symptoms varied from 1 day to 18 months. Inclusion criteria were patient history compatible with BPPV and positive provocative maneuver (either Dix-Hallpike or Roll test). A variant of Epley and Barbeque maneuver was used. The Epley maneuver was used for posterior and anterior canal involvement, and "Barbeque roll" was used for horizontal canal involvement. Short-term follow-up was obtained 48 hours and 7 days after initial treatment, whereas long-term follow-up was obtained at repeated 6 month intervals. RESULTS: The posterior semicircular canal was involved in 521 (88%) patients treated, whereas the horizontal and anterior semicircular canals were involved in 59 (10%) and 12 (2%) patients, respectively. Symptoms subsided immediately in 497 (84%) patients. In 77 (13%) patients, the Dix-Hallpike maneuver remained positive after 48 hours, and CRP was performed again. Patients' mean follow-up was 46 months; 544 (92%) of 592 patients treated reported no symptoms of vertigo. CONCLUSION: Our data, based on long-term follow-up, suggest that CRP remains an efficient and long-lasting noninvasive treatment for BPPV.

Tonsillectomy using the Ligasure vessel sealing system. A preliminary report.

OBJECTIVE: To evaluate and introduce a new method of tonsillectomy with the use of Ligasure vessel sealing system (LVSS) in pediatric population. METHOD: A prospective study was conducted on children undergoing tonsillectomy with the use of LVSS. Indications included chronic tonsillitis, peritonsilar abscess history, and obstructive sleep apnea syndrome. Patients undergoing adenoidectomy, or any procedure together with tonsillectomy, and patients with bleeding disorders were excluded. Among the available head-pieces, the 'Precise' instrument was used, both as haemostatic and dissection tool. Intraoperative bleeding, operative time, and complication rates, were evaluated. RESULTS: Our series consisted of 83 children among 103 patients undergone LVSS tonsillectomy. There was no measurable bleeding during surgery in any of the cases. In 18 children limited peritonsilar edema was noticed. No postoperative hemorrhage or other complication occurred. Mean operative time was 16 min. CONCLUSIONS: LVSS was found quite effective and safe, providing sufficient haemostasis, minimal intraoperative blood loss, and safety against the variant Creutzfeld-Jakob disease transmission.

Familial bilateral acinic cell carcinoma of the parotid synchronous with pituitary adenoma: case report.

BACKGROUND: Acinic cell carcinoma is a common neoplasm of the salivary glands that occurs predominately in the parotid. Only one case of a familial recurrence of such a neoplasm and 16 cases of bilateral tumors have been reported. METHODS: History files and histologic reports of a patient with bilateral multifocal acinic cell carcinoma of the parotid and a synchronous pituitary adenoma, and of the patient's sister and his father, also treated for parotid tumours, were retrieved. RESULTS: There was one recurrence of acinic cell carcinoma in the family. A pituitary tumor was a chromophobe gonotrophic adenoma. CONCLUSIONS: This is the 17th case of bilateral acinic cell carcinoma of the parotid gland and the second reported case with a familial recurrence. It is the first with a synchronous pituitary adenoma.

Otorhinolaryngology or otolaryngology? An etymological approach.

The variety and the confusion over the name of many medical terms, including otorhinolaryngological ones prompted us to search their etymology. The term "otorhinolaryngology" (combined form from the ancient Greek words :ous, rhina, larynx, and logos) and the term indicating the specialized doctor who practices "0torhinolaryngology," widely known as ENT in a brief version, are being examined. The investigation leads us to see which of these terms is the appropriate and etymologically correct one, and to support clearly the term "otorhinolaryngology" instead of "otolaryngology" and "otorhinolaryngologist" instead of "ENT."

ArF-193 excimer laser and Emdogain in the treatment of experimental periodontitis: an experimental study in rabbits.

OBJECTIVE: We aimed to investigate how the progress made on laser technology during the last ten years could overcome this obstacle and allow the use of lasers in periodontology, together with the application of a number of products permitting the regeneration of periodontal tissues. BACKGROUND DATA: The use of lasers in dentistry remains controversial, in spite of their increasing application in medical practice. The main reason for this discrepancy is the frequent report of damage to surrounding tissues and the dental pulp, due to the energy transfer, from the site of laser impact. METHODS: Experimental periodontitis was initiated in fifteen rabbits. Animals were divided into five equal groups. In the control group, no therapy was applied. The remaining four groups were treated with curettage or ArF 193 excimer laser, under conditions of strict control of frequency, fluency, and application, without or with the application of a periodontal healing product (Emdogain). Laser was applied by the use of a new, articulated arm for beam delivery. Pocket depth and microscopic analysis were performed three weeks after treatment. RESULTS: Our results show that all treatment groups decreased pocket depth significantly. ArF193 excimer laser does not produce any histological damage to the dental pulp, and facilitates periodontal regeneration. This result is highly facilitated by the application of Emdogain). CONCLUSIONS: The use of UV lasers, under a tight control of its energy, may be a valuable tool for the treatment of periodontal diseases, especially combined with the use of healing products. Further study is need to confirm these results.

The use of botulinum toxin type A in the treatment of Frey and crocodile tears syndromes.

PURPOSE: We sought to investigate the efficacy of botulinum toxin type A in the treatment of Frey and crocodile tears syndromes. Frey syndrome is a common complication after surgical intervention or injury in the region of the parotid gland. Crocodile tears syndrome is unusual and manifests after facial nerve paralysis and other causes such as head trauma. PATIENTS AND METHODS: This was a prospective nonrandomized, nonblinded study. We used botulinum toxin type A for the treatment of 11 patients with gustatory sweating and 2 patients with crocodile tears syndrome. RESULTS: The follow-up (6 to 23 months) of patients with gustatory sweating syndrome showed complete absence of sweating in the affected regions. One patient had recurrence after 16 months and was retreated successfully. At 1 and 24 weeks after treatment of the patients with the crocodile tears syndrome, the Schirmer test showed a reduction of stimulated lacrimation on the impaired side approaching the normal values of the unaffected side. CONCLUSIONS: Our study supports the widely accepted aspect that botulinum toxin type A could be the treatment of choice for gustatory sweating syndrome. We also propose the toxin as a valuable treatment for crocodile tears syndrome.