BAHA Attract to Osia conversion patients: comparison of the two systems and long-term outcomes.

OBJECTIVE: Osia is a new, transcutaneous, active bone-conduction implant. This study aimed to compare the BAHA Attract and the first-generation Osia system after BAHA Attract to Osia conversion surgery. METHOD: Five patients who had previously used the BAHA Attract system were converted to the first generation of the Osia system. Surgical aspects of the two different systems, audiological performance and subjective opinions of the patients were investigated. Pure tone audiometry and speech audiometry in quiet was performed with each patient's BAHA 5 sound processor on Attract, and the test battery was repeated six weeks after the Attract to Osia conversion and at different time points after the first fitting. Details of the surgery and patients' feedback were analysed. RESULTS: Audiology tests showed significant improvement when using either system; however, the Osia system performance was better. Based on patient feedback, all the five implantees preferred the Osia system. CONCLUSION: The study results suggest that the Osia system is a safe and powerful hearing implant that provides good clinical outcomes.

Early experience on a modern, thin cochlear implant family. A retrospective, international multicenter study.

RATIONALE: Cochlear implantation is the most effective method of rehabilitation for patients with severe to profound sensorineural hearing loss. Binaural hearing forms the basis of the development of hearing-associated cortical networks in infants and toddlers, but simultaneous bilateral implantation is often postponed due to the demands of classical surgical methods, which are associated with large incisions and a deep bony well. OBJECTIVE: The authors report on the use of a modern, thin implant type and the possibilities it provided to simplify the surgical technique. METHODS AND RESULTS: Recent models of the Cochlear™ Nucleus® implant family were studied in an international retrospective multi-center study: 6 otolaryngologists in 5 centers shared their experiences on 73 consecutively implanted, thin implants. The surgical incision could be made shorter than before and only shallow bony wells or none at all were created in 4 out of 5 centers. No complications occurred. DISCUSSION: This study underlines that implants with thin electronics capsules enable a simplified, fast and safe implantation procedure that allows simultaneous bilateral cochlear implantation.

The effect of nasal provocation with a single-dose allergen on the physical and cognitive performance of patients with ragweed allergy.

Purpose This study aims to compare the impact of active allergic rhinitis on physical and cognitive abilities of trained allergic athletes to untrained allergic patients. Methods Cognitive, respiratory, and fitness functions were assessed before and after allergen exposure. Participants in both groups were provoked intranasally with ragweed allergen. Results The group of athletes revealed significantly higher average values in peak inspiratory flow and fitness index before and after provocation. In neuropsychological assessments, athletes performed significantly better after allergen provocation in complex working memory capacity. Due to single acute allergen exposure, the size of the nasal cavity and nasal inspiratory peak flow significantly decreased in both groups. The physical performance of both groups did not change after provocation. Executive functions and complex working memory capacity of athletes significantly improved resulting from provocation. Conclusions A single-shot allergen in high dose might cause an increase in mental concentration, which was more pronounced in the group of athletes. This study indicates that acute exposure to allergen cannot affect the physical performance and may result in increased mental focus in patients with allergy notwithstanding the declining respiratory functions.

Biodegradable airway stents in infants - Potential life-threatening pitfalls.

OBJECTIVE: The solution of severe tracheobronchial obstructions in early childhood means a great challenge. Biodegradable stents were intended to be a minimally invasive temporary solution which may decrease the number of interventions and limit the possible complications of stenting procedures. However, our first experiences have brought out a new, - especially in childhood - potentially life-threatening complication of this concept. METHODS: Five SX-ELLA biodegradable polydioxanone stents was applied in three patients because of severe tracheobronchial obstruction: congenital tracheomalacia (7 day-old), acquired tracheomalacia (10 month-old), and congenital trachea-bronchomalacia (10 month-old). RESULTS: The breathing of all children improved right after the procedure. We observed degradation of the stent from the 5th postoperative week which resulted in large intraluminar fragments causing significant airway obstruction: one patient died of severe pneumonia, the other baby required urgent bronchoscopy to remove the obstructing 'foreign body' from the trachea. In the third case repeated stent placements successfully maintained the tracheal lumen. CONCLUSIONS: Polydioxanone stents may offer an alternative to metallic or silastic stents for collapse or external compression of the trachea in children; however, large decaying fragments mean a potential risk especially in the small size pediatric airway. The fragmentation of the stent, which generally starts in the 4-6 postoperative weeks, may create large sharp pieces. These may be anchored to the mucosa and covered by crust leading to obstruction. As repeated interventions are required, we do not consider the application of biodegradable stents unambiguously advantageous.

Clinical assessment of a new computerised objective method of measuring facial palsy.

OBJECTIVE: To compare the results using a new computerised objective method of assessing the degree of facial palsy with the results obtained using traditional clinical methods. DESIGN: Prospective computerised pixel change analysis and clinical evaluation of videos. SETTING: Tertiary referral centre. PARTICIPANTS: Subjects with varying degrees of unilateral facial palsy. METHODS: Comparison of the results obtained from an objective computerised method, the Glasgow Facial Palsy Scale, with the standard subjective clinical methods of the House-Brackmann Scale, Yanagihara, Sunnybrook Grading Scales and the objective clinical Stennert-Limberg-Frentrup Scale. RESULTS: Statistical analysis of the results from the objective computerised system indicated that there is an averagely strong correlation with the results from the House-Brackmann (Spearman's coefficient of 0.64), Sunnybrook (Pearson coefficient of 0.7) and Stennert-Limberg-Frentrup Scale (Pearson coefficient of 0.65), and it therefore has the ability to produce consistent results that agree with traditional clinical methods. It has a strong correlation with the Yanagihara Grading Scale (Pearson coefficient of 0.72) indicating that it may also have the ability to detect and record variations in the different regions of the face. CONCLUSION: This new computerised objective method of assessing the degree of facial palsy shows promise as a standardised objective method of assessing the degree of facial palsy.

The combined endoscopic management of congenital laryngeal web.

Laryngeal web in the anterior commissure is a rare congenital anomaly often leading to severe dyspnea. Endoscopic procedures based on a simple transsection in these cases may worsen the condition because vocal folds have a tendency for fibrosis and granulation tissue formation after surgical interventions. Thus the traditional treatment of choice is the demanding, externally performed laryngotracheal reconstruction generally with a rib cartilage graft and longer period of stenting. This report presents the successful endoscopic management of a congenital laryngeal web in a 2-year-old boy, who previously underwent an uneffective scar laser transsection that led to excessive glotto-subglottic refibrosis. After the CO(2)-laser transsection the authors applied Mitomycin-C and inserted a combined silicon stent by extra-endolaryngeal technique. After the removal of the stent the patient could be decannulated and his voice improved. The application of these minimally invasive endoscopic techniques was successful, hence it may be an effective alternative treatment option for laryngeal webs.

Pharyngeal and hypopharyngeal reconstruction after multilating surgery for malignant hypopharyngeal cancers.

The authors summarise their reconstructive surgical experience after the radical excision of hypopharyngeal tumours. In selective cases the preservation of the larynx is a reliable surgical option and supraglottic surgery is sufficient to remove the tumour. Myocutaneous paddle flaps were used in every case after the surgical resection for the reconstruction of the pharyngo-oesophageal entrance. After total circular pharyngo-laryngectomy, the continuity of the upper digestive tract was reconstructed by tubed myocutanous flaps.

Distortion-product otoacoustic emission (DPOAE) following pure tone and wide-band noise exposures.

The aim of our investigations was to determine how the intensity of distortion-product otoacoustic emission (DPOAE) changes following different sound and noise exposures. We performed examinations on 20 healthy people with normal hearing. DPOAEs were recorded scanning the 0.5-6 kHz frequency interval before and after the exposures. We exposed the subjects to 0.5, 1, 2, 4 and 6 kHz pure tones and wide-band noise (intensity: 80 dB HL, duration: 3 minutes). We conclude that the amplitudes of DPOAEs changed immediately after exposures at most frequencies. DPOAE intensities decreased at some frequencies in the middle frequency range (1-2 kHz), and increased at low and particularly at high frequencies.

Brainstem auditory-evoked potential examinations in diabetic patients.

Brainstem auditory-evoked potential (BAEP) examinations were performed in 15 patients with long-standing type-1 diabetes mellitus (DM). Cardiovascular reflex tests were applied for assessment of autonomic neuropathy. The aim of our investigation was to compare the BAEP results of this patient group with controls and to look for a possible correlation between the alteration of the auditory brainstem function and the cardiovascular autonomic neuropathy. Analysis of the latencies (waves I, II, III and V) and the inter-peak latencies (waves I-III and I-V) of BAEPs revealed a significant difference between diabetics and healthy controls. The amplitudes of waves I, III and V were definitely lower in comparison with those of healthy controls. A positive correlation was observed between the overall autonomic score and the latencies (waves III and V) and inter-peak latencies (waves I-III and I-V). These data support the hypothesis that long-standing DM and diabetic neuropathy might be related as a cause of certain dysfunctions of the central auditory pathways.

"Early" vocal cord laterofixation for the treatment of bilateral vocal cord immobility.

OBJECTIVES: Vocal cord immobility (VCI) is commonly caused by a nonlaryngeal malignancy, thyroid surgery, or a presumed viral insult etc. The paralysis is often transient or temporary, thus the care of the patient should be optimized to avoid unnecessary diagnostic and therapeutic endeavours. This article reports on the result of the concept of early vocal cord laterofixation, which provides a minimally invasive solution to dyspnea in the critical early, potentially reversible, period of bilateral VCI. STUDY DESIGN: A prospective study of 25 consecutive patients (ages 33 to 81 years) who were diagnosed with a bilateral VCI. This condition had developed after thyroid surgery in 22 of the patients and after a blunt trauma of the neck in one case. In another case, a cricoarytenoid joint fixation was revealed, and aetiology remained unknown in one further patient. METHODS: The surgical procedure was performed endoscopically with a modification of Lichtenberger's endo-extralaryngeal suture lateralization technique. The abducted vocal cord position was achieved by inserting a non-resorbable thread around the vocal process and tying on to the prelaryngeal muscles. Regular spirometric measurements and radiological aspiration tests were conducted on the patients. RESULTS: Adequate postoperative airway was achieved in all patients except one. Significant spontaneous vocal cord medialization was observed in two cases within a year and in three patients in the second and the third year. Partial or complete vocal cord recovery was observed in 17 cases. Further voice improvement followed in 9 patients when the threads were removed, due to vocal cord medialization or recovery. The mild postoperative aspirations ceased in the first postoperative days in all cases except one. CONCLUSIONS: The concept of "early" laterofixation satisfies the important criteria: it can provide an immediate and long-lasting adequate airway, and it can be considered potentially reversible from the point of view of laryngeal functions. Thus the procedure is a reliable primary treatment for bilateral VCI.

Combined use of endoscopic CO2 laser excision of a marginal laryngeal tumor, radical neck dissection, and perioperative laterofixation of the opposite vocal cord.

We report the use of endoscopic laser excision of a marginal laryngeal tumor, radical neck dissection, and laterofixation of a paralyzed vocal cord in a 66-year-old man who had an early-stage right supraglottic endolaryngeal tumor and ipsilateral neck metastasis. He had a left vocal cord paralysis after a left pneumonectomy that was performed 5 years previously. The primary laryngeal tumor was excised by endoscopic CO2 laser resection, and a simultaneous radical neck dissection was carried out. Postoperatively, severe inspiratory dyspnea developed because of the surgical intervention on the right side causing moderate laryngeal edema and limited movement of the right vocal cord in addition to the paralyzed left side. An endolaryngeal laterofixation of the paralyzed left vocal cord was performed to provide the patient with an adequate airway instead of tracheostomy. This patient had a 2 years' follow-up without recurrence of tumor. In the meantime movement of the right vocal cord has returned, so that the patient's voice was socially acceptable and he has a functioning larynx.

Airway complication after thyroid surgery: minimally invasive management of bilateral recurrent nerve injury.

OBJECTIVES: After bilateral vocal cord paralysis, the consequent paramedian position usually necessitates tracheostomy for at least 6 months, when the paralysis is potentially reversible. In the present study a reversible endoscopic vocal cord laterofixation procedure was used instead of tracheotomy. STUDY DESIGN: Prospective study of 15 consecutive patients aged 33 to 73 years who suffered bilateral recurrent laryngeal nerve paralysis after thyroid surgery. METHODS: The operation was performed endoscopically with a special endo-extralaryngeal needle carrier instrument. Two ends of a monofilament nonresorbable thread were passed above and under the posterior third of the vocal cord and knotted on the prelaryngeal muscles, permitting the creation of an abducted vocal cord position. If movement of one or both vocal cords recovered, the suture was removed. Regular spirometric measurements and radiological aspiration tests were conducted on the patients. RESULTS: During the follow-up period of 3 to 40 months, airway stability was demonstrated in all but one patient. After the repeated lateralization procedure, this patient's breathing improved. Partial or complete vocal cord recovery was observed in eight patients. In six patients further voice improvement was achieved when the threads were removed after vocal cord medialization or recovery. Mild postoperative aspirations ceased in the first postoperative days. CONCLUSIONS: This management approach offers an alternative to tracheostomy in the early period of paralysis, avoids terminal loss of voice quality, and provides a "one-stage" solution for permanent bilateral recurrent nerve injuries.

Minimally invasive surgery for posterior glottic stenosis.

Posterior glottic stenosis most commonly results from prolonged endotracheal intubation. The tube causes decubitus and perichondritis with a consequent scar tissue formation in the posterior commissure that often limits the abduction of the vocal cords. Many different surgical methods are known for the treatment, but in most cases temporary tracheostomy is required. We recommend a minimally invasive method to avoid tracheostomy, which is a very inconvenient state for the patient. The scar of the posterior commissure is excised endoscopically with the CO2 laser, and a modification of the endoextralaryngeal vocal cord laterofixation described by Lichtenberger is used to lateralize 1 or both vocal cords until the posterior commissure is completely reepithelialized. In this article we report on the first 5 cases. All patients had satisfactory airways immediately after the laterofixation procedure, which proved to be stable later on as well. In the cases of moderate stenosis, further scarring was prevented, and after the healing of the mucosa in the posterior glottic area, the laterofixation sutures were removed. The vocal cord mobility was recovered in the cases in which the cricoarytenoid joint was not fixed. In 1 case of severe stenosis (bilateral cricoarytenoid joint fixation), the procedure yielded only partial improvement.

[Endolaryngeal lipoaugmentation of the vocal cords]. / Endolaryngealna lipoaugmentacja strun glosowych.

Unilateral vocal cord paralysis or the loss of vocal cord tissue results in incomplete glottic closure (internal-paresis) with a consequent hoarseness and poor voice quality. Improving glottic incompetence, instead of the previously used paraffin, teflon is a widely accepted and most commonly used substance at present for vocal cord medialization. Using intracordal teflon injection of for decades had proven that it has limitations and potential complications to the human body. Beside the well-known external "phono-surgical" methods, a wide interest has been shown in endolaryngeal phono-surgery and in finding the ideal and most available biocompatible substances for the procedure. Papers have been issued about the promising results of autologus fat injection for medialization of the paralyzed vocal fold in the early '90s. In this paper the authors report on their slightly modified endolaryngeal intracordal autologus fat injection procedure, and its promising results. The first three patients (a left side glottic paralysis, a bilateral internal paresis and a left side internal paresis) experienced an improvement in their voice right after the medialization procedure, what remained the same during the 11 months follow-up period. Using supraglottic jet ventilation during general anaesthesia provides very good access to the operating field. Monitoring of neuro-muscular block makes possible an intraoperative examination of glottic closure by the protective reflex of the larynx. Incouraged by this initial results the authors suggest the autologus fat as an easy available, ideal substance for increasing (augmenting) the loss of vocal cord tissue.

Vocal cord laterofixation as early treatment for acute bilateral abductor paralysis after thyroid surgery.

Bilateral vocal cord palsy due to a lesion of the recurrent laryngeal nerves is a serious complication of thyroid operations, with the airway obstruction usually necessitating tracheostomy. In the cases presented, a stable airway was ensured with endolaryngeal cord laterofixation instead of tracheostomy. The operation was performed with the endo-extralaryngeal needle carrier instrument devised by Lichtenberger. During the operation, only minor surgical trauma occurred in the larynx. The fixing thread was then removed following recovery of contralateral vocal cord function, resulting in an improvement in the voice. Four patients are described who suffered bilateral recurrent laryngeal nerve palsy after thyroid gland operations. During the follow-up period of 3-12 months, airway stability was demonstrated by regular spirometric measurements. The simple method recommended spares patients the possible complications of tracheostomy.