Efficacy of mandibular advancement device in the treatment of obstructive sleep apnea syndrome: A randomized controlled crossover clinical trial

BACKGROUND: Evaluation of the efficacy and safety of a mandibular advancement device (MAD) (KlearwayTM) in the treatment of mild-to-moderate obstructive sleep apnea and chronic roncopathy. MATERIAL AND METHODS: A randomized, placebo-controlled, double blinded, and crossover clinical trial was conducted. Placebo device (PD) defined as a splint in the centric occlusion that did not induce a mandibular advancement served as a control. The mandible was advanced to the maximum tolerable distance or to a minimum of 65% of the maximum protrusion. After each sequence of treatment, patients were assessed by questionnaires, conventional polysomnography, and objective measurement of snoring at the patient's own home. RESULTS: Forty two patients participated in the study and 38 completed the study. Patients mean age was 46 ±9 years and the 79% were males. The mean mandibular advancement was 8.6 ±2.8 mm. Patients used the MAD and the PD for 6.4 +2.4 hours and 6.2 +2.0 hours, respectively. Secondary effects (mostly mild) occurred in the 85.7% and the 86.8% of the users of MAD and PD, respectively. The MAD induced a decrease in the apnea-hypopnea index (AHI) from 15.3 +10.2 to 11.9 +15.5. The 50% reduction in the AHI was achieved in the 46.2% and the 18.4% of the patients treated with MAD and PD, respectively. The use of the MAD induced a reduction in the AHI by 3.4 +15.9 while the PD induced an increase by 10.6 +26.1. The subjective evaluation of the roncopathy indicated an improvement by the MAD and an increase in the perceptive quality of sleep. However, the objective evaluation of the roncopathy did not show significant improvements. CONCLUSIONS: The use of MAD is efficient to reduce the AHI and improve subjectively the roncopathy. MAD could be considered in the treatment of mild-to-moderate OSA and chronic roncopathy

Efficacy of mandibular advancement device in the treatment of obstructive sleep apnea syndrome: A randomized controlled crossover clinical trial.

BACKGROUND: Evaluation of the efficacy and safety of a mandibular advancement device (MAD) (KlearwayTM) in the treatment of mild-to-moderate obstructive sleep apnea and chronic roncopathy. MATERIAL AND METHODS: A randomized, placebo-controlled, double blinded, and crossover clinical trial was conducted. Placebo device (PD) defined as a splint in the centric occlusion that did not induce a mandibular advancement served as a control. The mandible was advanced to the maximum tolerable distance or to a minimum of 65% of the maximum protrusion. After each sequence of treatment, patients were assessed by questionnaires, conventional polysomnography, and objective measurement of snoring at the patient's own home. RESULTS: Forty two patients participated in the study and 38 completed the study. Patients mean age was 46 ±9 years and the 79% were males. The mean mandibular advancement was 8.6 ±2.8 mm. Patients used the MAD and the PD for 6.4 +2.4 hours and 6.2 +2.0 hours, respectively. Secondary effects (mostly mild) occurred in the 85.7% and the 86.8% of the users of MAD and PD, respectively. The MAD induced a decrease in the apnea-hypopnea index (AHI) from 15.3 +10.2 to 11.9 +15.5. The 50% reduction in the AHI was achieved in the 46.2% and the 18.4% of the patients treated with MAD and PD, respectively. The use of the MAD induced a reduction in the AHI by 3.4 +15.9 while the PD induced an increase by 10.6 +26.1. The subjective evaluation of the roncopathy indicated an improvement by the MAD and an increase in the perceptive quality of sleep. However, the objective evaluation of the roncopathy did not show significant improvements. CONCLUSIONS: The use of MAD is efficient to reduce the AHI and improve subjectively the roncopathy. MAD could be considered in the treatment of mild-to-moderate OSA and chronic roncopathy.

Neurinoma de la cuerda del tímpano / Chorda tympani neuroma

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Bilateral congenital absence of the stapes superstructure in two siblings.

Middle ear ossicle malformations are an uncommon event. Among them, the congenital absence of the stapes is a very rare condition that is seldom described in the literature. We report the cases of two women, aged 19 and 22 , who presented with a long history of conductive deafness. An exploratory tympanotomy was performed and the absence of the stapes superstructure and an abnormal position of the facial nerve could be observed. A bone anchored hearing aid (BAHA) was implanted in both patients with good results. It is believed that stapes agenesis is related to an abnormal development of the facial nerve, which by the 5th to 6th week of gestation would interpose between the otic capsule and the stapes blastema, preventing these structures from contacting. A long history of nonprogressive hearing loss from birth or early childhood is the key to reach a diagnosis. Several treatment options have been described. The authors opted for a hearing aid due to the high risk of facial nerve lesion, with good functional results.

Influence of aging and menopause in the origin of the superior semicircular canal dehiscence.

OBJECTIVE: Determine if aging and menopause, known to be associated with bone resortion, also are associated with superior semicircular canal dehiscence. DESIGN: Observational study. SETTING: Study conducted in 3 tertiary Spanish hospitals. PATIENTS: Nonselected consecutive patients of all ages. INTERVENTIONS: Thin-section multi-detector row computed tomographic scan of the temporal bones. MAIN OUTCOME MEASURE: The minimum thickness of the bone covering the roof of the superior semicircular canal (SSC) measured in each temporal bone. The outcome was studied both as a continuous and as a dichotomous variable: thin (<0.6 mm) and normal (≥ 0.6 mm). RESULTS: Five hundred eighty-two ears of 312 patients were included in the study. Fifty-five percent of the sample were women. Patient's age ranged from 2 to 88 years. A 40-year age difference between ears was associated with a decreased thickness of bone covering the SSC of 0.10 mm, which is 10% of the average thickness of such bone. The thickness of the bone overlying the SSC of subjects younger than 45 years was an average of 1.14 mm (SD, 0.52 mm), whereas that of the subjects older than 45 years was equal to 1.02 mm (SD, 0.45 mm; p = 0.006). The percentage of ears with thin bone coverage of SSC was 7.1% in subjects younger than 45 years and 13.8% in those older than 45 years (p = 0.013). CONCLUSION: Our data support the hypothesis that there is a slight osteopenia of the roof of the superior semicircular canal associated with aging, and this effect seems to be more pronounced in menopausal women.

WITHDRAWN. Universal neonatal hearing screening versus selective screening as part of the management of childhood deafness.

BACKGROUND: The principal factors that decide how deafness affects a child's development are the degree of hearing impairment and the age at which it is diagnosed. A number of factors are thought to increase the risk of hearing impairment: low birth weight, prematurity, perinatal hypoxia and jaundice, among others. The high incidence of deafness in children without risk factors and the introduction of simple new screening tests of high sensitivity and specificity have led many prestigious bodies to recommend universal early detection programmes for deafness rather than screening targeted only at high-risk groups. OBJECTIVES: To compare the long-term effectiveness of a universal neonatal screening and early treatment programme for hearing impairment with: a) screening and treatment only of high-risk neonates and b) opportunistic screening and treatment. SEARCH STRATEGY: Databases searched included MEDLINE (1966 to 2006), EMBASE (1974 to 2006), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2006) and registers of health technology assessment agencies as well as registers of clinical guidelines. The date of the last search was June 2006. SELECTION CRITERIA: Randomised controlled trials comparing universal neonatal screening with either high-risk screening or opportunistic screening for hearing impairment. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the search results to identify suitable trials. MAIN RESULTS: No studies were identified which fulfilled the inclusion criteria. AUTHORS' CONCLUSIONS: The long-term effectiveness of universal newborn hearing screening programmes has not been established to date. There is a need for controlled trials and before and after studies to address this issue further.