Preoperative evaluation, surgical procedure, follow up and results of 150 cochlear implantations.

BACKGROUND: The cochlear implantation is among the most important achievements of medicine and biotechnology in the last 20 years, because it allows individuals who had never heard or had lost their hearing to perceive sound and improve their quality of life. Selection criteria for candidates are strict and are evaluated in each individual by a scientific committee specially trained for implantations which includes Ear Nose and Throat (ENT) surgeon, audiologist, psychiatrist and speech therapist. PATIENTS AND METHODS: In our department, the first cochlear implantation was performed in 1995. During the last ten years more than 250 individuals have been evaluated due to profound hearing loss and 170 of them were found to be suitable candidates for cochlear implantation. One hundred and fifty (150) have already been operated and most of them are children with congenital hearing loss. No major or permanent complications were recorded in any of our 150 patients. Activation and fitting/mapping of the cochlear implant is initiated three weeks post-operatively. Regular follow-up and mapping of the implant are held, more frequently in children, along with specialized speech therapy. Each new mapping is evaluated according to the record of the patient with regard to the acoustic perception of sounds and speech and the discrimination of individual elements of phonation based on a protocol that we have created for the needs of Greek language. RESULTS: Speech discrimination (AHEPA Hospital protocol), before the Implantation, at the activation of the cochlear implant and till 4 years of the follow-up showed that in our patients, we obtained better and faster results in post-speech acquisition adults with recent or chronic deafness and in children with congenital deafness operated before the 5th year of age, who underwent special preoperative speech therapy programme, fact which is in agreement with current literature. Patient satisfaction evaluated by "Sanders" psychometrics tests, was achieved in accordance to pre-operative expectations. CONCLUSIONS: In our patients, we observed better and faster results in children with congenital deafness operated before the third year of age, in post-speech acquisition adults with recent deafness and in post-speech acquisition adults with chronic deafness but with auditory memory reserve.

Supraglottic laryngectomy: experience with 66 patients over 20 years.

We reviewed the records of 66 consecutive patients with previously untreated supraglottic laryngeal carcinoma who underwent a supraglottic laryngectomy in our department between 1970 and 1989. There were 23 T1, 30 T2 and 13 T3 cases. Eight patients had neck metastases and underwent neck dissection also. Twenty-four (36 per cent) patients received post-operative radiotherapy. Two-year and five-year survival rates were 88.9 per cent and 82.2 per cent respectively. When the survival rates of the patients with T1, T2 and T3 lesions were calculated separately and compared with each other the differences were not statistically significant. Recurrences, post-operative complications, time to progression and indications for supraglottic laryngectomy are discussed.

Posterior pharyngeal wall schwannoma (case report).

A rare case of a schwannoma localized on the posterior pharyngeal wall is presented. It concerns a young man with an inflammatory ulcerated mass in the posterior wall of the pharynx causing severe difficulty in swallowing. Although schwannomas of the lateral pharyngeal wall are common, only one case located on the posterior wall has been described. The origin of these tumours at this particular site is thought to be the sympathetic nervous plexus of the posterior pharyngeal wall. In presenting our case, we comment on the origin of posterior pharyngeal wall schwannomas.

Malakoplakia of the larynx.

The first case of malakoplakia of the larynx in the world literature is reported. The soft raised plaques were removed from a 61-year-old white male, who was a heavy smoker and complained of hoarseness, but was otherwise in good general condition. From the follow-up of our patient, it is concluded that malakoplakia is not of particularly bad prognosis when affecting the larynx, and that simple local excision seems to be enough to produce cure. On these grounds, the laryngologists should be aware of the entity and consider it when dealing with raised nodules or plaques in the larynx, while the pathologists should be alert to look for the Michaelis-Gutman bodies, when encountered with peculiar histiocytic reactions anywhere in the body, even in the larynx.

Foreign body in the airways: a review of 90 cases.

Despite the progress made in the fields of endoscopy and anesthesia for children, as well as the accumulated experience, the inhalation of foreign bodies remains a serious and often dramatic problem. Every case varies to some extent, and only general conclusions may be drawn. The retroactive analysis of the documents from every case that was treated at the Ear, Nose, and Throat Clinic of the Aristotelian University from 1970 to 1975, as well as the comparative statistical study, show common characteristics shared by all 90 cases under consideration. In these cases, the foreign body was of organic origin (mainly seeds and dry fruits) and particularly pumpkin seeds (25% of all cases). Half of the patients sought hospitalization, with a delay varying from two days to four months, while localization varied (larynx, 11 cases; trachea, 10; bronchus, 69). Localization in the left bronchus was more frequent than in the right one, especially in children. The diagnosis was based on the case history, clinical examination, and radiologic findings, while in the majority of the cases, the treatment involved bronchoscopy, the removal of the foreign body, and treatment of lung problems in delayed cases.

[Fibrosarcoma of the head and neck. Diagnosis and therapy (author's transl)]. / Fibrosarkome an Kopf und Hals. Diagnose und Therapie.

We report about two patients with fibrosarcoma of the soft tissues of the face. We discuss the problems of biological viability of the tumor, of the diagnostics and of the etiological factors, and about the therapy. The prognosis depends on the localisation, the degree of malignancy of the tumor and the therapy.