Multiple symmetric lipomatosis: a review of 3 cases.

Multiple symmetrical lipomatosis, or Madelung's disease, is a rare disease of unknown etiology. It is characterized by the presence of loose adipose tissue deposits localized in the cervical region and in the upper body. The neoformations grow slowly and their initial consequence is purely esthetic. They can, however, lead to compression of the laryngotacheal area and of the esophagus. This disease usually affects middle-aged males from the Mediterranean area with a history of alcohol abuse. Although most cases have been sporadic, a few authors have indicated that the disorder may be hereditary. It is thought that this pathology originates from an alteration in lipid metabolism. Since the patients were asymptomatic temperance and diet was proposed, surgical removal of the lipomatose mass is the treatment of choice in case of complications due to fat mass compression on upper aerodigestive tract. The authors present three cases of Madelung's disease with different and particular manifestations.

Comparing postoperative quality of life in children after microdebrider intracapsular tonsillotomy and tonsillectomy.

OBJECTIVE: To evaluate postoperative quality of life in patients undergoing microdebrider intracapsular tonsillotomy and adenoidectomy (PITA) in comparison with traditional adenotonsillectomy (AT) and to assess PITA's efficacy in solving upper-airway obstructive symptoms. METHODS: 29 children with adenotonsillar hyperplasia referred for AT were included. Patients were divided into two groups: Group 1 (underwent PITA) included 14 children (age 5.1±1.8 years) affected by night-time airway obstruction without a relevant history of recurrent tonsillitis; Group 2 (underwent AT) included 15 children (age 5.2±1.7 years) with a history of upper-airway obstruction during sleep and recurrent acute tonsillitis. Outcomes measures included the number of administered pain medications, time before returning to a full diet, Obstructive Sleep Apnea survey (OSA-18), parent's postoperative pain measure questionnaire (PPPM) and Wong-Baker Faces Pain Rating Scale (WBFPRS). RESULTS: Postoperative pain was significantly lower in the PITA group, as demonstrated by PPPM and WBFPRS scores and by a lower number of pain medications used. PITA group also resumed a regular diet earlier (P<0.001). OSA-18 scores proved that both PITA and AT were equally effective in curing upper-airway obstructive symptoms. CONCLUSION: PITA reduces post-tonsil ablation morbidity and can be a valid alternative to AT for treating upper-airway obstruction due to adenotonsillar hyperplasia.

Voice therapy for laryngeal hemiplegia: the role of timing of initiation of therapy.

OBJECTIVE: Laryngeal hemiplegia, also known as vocal fold paralysis, causes severe communicative disability. Although voice therapy is commonly considered to be beneficial for improving the voice quality in several voice disorders, there are only a few papers that present scientific evidence of the effectiveness of voice therapy in treating the disabilities of laryngeal hemiplegia. The aim of this study was to evaluate the outcomes of voice therapy in patients with laryngeal hemiplegia and to evaluate the role of the time gap between onset of laryngeal hemiplegia and initiation of therapy. DESIGN: A prospective study comparing subjects treated either within or more than 3 months after the onset of laryngeal hemiplegia. SUBJECTS: The study involved 30 laryngeal patients with hemiplegia (16 males, 14 females, age range 15-80 years). METHODS: All patients underwent videolaryngostroboscopy, maximum phonation time measurement, GIRBAS perceptual evaluation, Voice Handicap Index self-assessment and Multi-Dimensional Voice Program voice analysis before and after therapy. RESULTS: In all tests, there were significant improvements in voice quality, both in the group treated within 3 months after the onset of laryngeal hemiplegia and in the group treated after this time. CONCLUSION: Voice therapy is effective in treating laryn-geal hemiplegia even if treatment is delayed by more than 3 months from onset of laryngeal hemiplegia.