Oral appliance therapy for snoring and sleep apnea: preliminary report on 86 patients fitted with an anterior mandibular positioning device, the Silencer.

There has been a great deal of interest recently in snoring and obstructive sleep apnea (OSA) by both dental and medical professions, as well as the media. Oral appliance therapy has been recognized by many sleep disorder specialists as the primary treatment of choice for snoring and mild to moderate OSA. Continuous positive airway pressure (CPAP) is the gold standard treatment for severe OSA, with oral appliance therapy reserved for CPAP failures. CPAP therapy has a compliance rate of 50 to 70%. The author has had experience with anterior mandibular positioning devices, in particular, Dr. Wayne Halstrom's Silencer for approximately 2 years. All patients are thoroughly investigated to include a polysomnogram (PSG) to assess the degree of snoring and OSA. Patients who are suitable candidates for oral appliance therapy are offered a temporary appliance with a follow-up PSG prior to fitting with the permanent appliance or initially with a more comfortable, custom-fitted permanent appliance. In either case, attempts are made to convince the patients of the necessity for a follow-up PSG to evaluate the efficacy of the device. The results, as well as potential harmful side effects and complications, are presented and are compared with the results of other recent studies.

Ten-year experience with percutaneous bone-anchored hearing aids: a 3- to 10-year follow-up Markham Stouffville Hospital, 1990 to 2000.

Patients with bilateral conductive hearing losses continue to be a source of frustration for both otologists and audiologists. Efforts to rehabilitate their hearing have included medical and surgical treatment, as well as the use of conventional hearing aids and, less frequently, conventional bone-conduction hearing aids. In the late 1980s, a percutaneous bone-anchored hearing aid (BAHA) developed by Dr. A. Tjellström, as an offshoot of Dr. P. I. Brånemark's work on osseointegration of titanium and bone, became commercially available. The BAHA has become a high-performing, comfortable, and aesthetically pleasing sound processor. The results of a 10-year BAHA program based at Markham Stouffville Hospital are summarized. In particular, a retrospective review of the 76 patients implanted between 1990 and 1997 is reported (i.e., a 3- to 10-year follow-up). Recent innovations to the design of the BAHA will be described that will further improve the quality of life for these patients.