Is there a better way to do laser-assisted uvulopalatoplasty?

OBJECTIVE: To assess the subjective and objective short- and medium- to long-term results of laser-assisted uvulopalatoplasty (LAUP) for snoring and obstructive sleep apnea. DESIGN: A nonrandomized, prospective, before-after trial. PATIENTS AND INTERVENTIONS: Twenty-five patients underwent a modified procedure of LAUP termed one-stage LAUP, and a matched control group of 24 patients underwent uvulopalatopharyngoplasty. MAIN OUTCOME MEASURES: Subjective analysis of LAUP included a preoperative and 2 postoperative evaluations of the state of snoring (4 weeks and after a mean +/- SD of 12.2 +/- 9.9 months). A score on 5 other sleep-related symptoms was recorded before and after completion of LAUP. The objective polysomnographic outcomes were compared with a control group undergoing uvulopalatopharyngoplasty. RESULTS: In 25 patients, improvement in the state of snoring significantly declined from 76% (n = 19) to 32% (n = 8), and worsening increased from 12% (n = 3) to 32% (n = 8) (P<.001). Evaluation of 5 other sleep-related symptoms showed that 52% of patients (n = 13) improved and 20% (n = 5) worsened. Polysomnography of LAUP patients showed that the mean postoperative respiratory disturbance index worsened significantly (33.1 +/- 23.1) compared with the preoperative one (25.3 +/- 14.3) (P =.05); also, 20% of the procedures were successful and 36% revealed marked worsening. The respiratory disturbance index of uvulopalatopharyngoplasty patients changed from 26.0 +/- 18.0 to 18.7 +/- 21.3, yet improvement did not reach statistical significance (P =.09). Furthermore, 58% (n = 14) of the surgical procedures were successful and only 8% (n = 2) revealed marked worsening. CONCLUSIONS: The favorable, subjective, short-term results of modified LAUP deteriorated over time. The procedure might also lead to aggravation of existing apnea. These findings are probably related to progressive palatal fibrosis and velopharyngeal narrowing originated by the laser beam.     

Bilateral cochlear implants: a way to optimize auditory perception abilities in deaf children?

OBJECTIVES: The Würzburg bilateral cochlear implant (CI) program was started with the aim to improve the patients' communicative abilities in complex listening situations. In this study, the auditory skills of children using bilateral cochlear implants were evaluated. STUDY DESIGN AND SETTINGS: Qualitative data based on free observations in the rehabilitation setup were collected in 39 bilaterally implanted children. A speech discrimination in noise test was performed in 18 of these children; lists of bisyllabic words were presented in noise at a signal to noise ratio (SNR) of +15 dB. RESULTS: Qualitative and quantitative data show clearly that bilateral CI improves the children's communicative behaviour, especially in complex listening situations. Children examined with the speech in noise test scored significantly better under the bilateral condition compared to the unilateral condition. Integration of the second implanted side and use of binaural information was observed to be easier and faster in children with a short time lag between both implants. CONCLUSIONS: To be able to obtain optimal benefit from bilateral cochlear implants, an intensive rehabilitation program is necessary. The important aspects of such a program are creating realistic expectations in older children before implantation; performing the first processor fitting of the second side with the first side switched on; and separate intensive training with the new system in order to balance out the hearing competence of the second CI with that of the first.     

Treatment of cervical paragangliomas: Is surgery the only way?

Purpose

To analyze the results after surgery or stereotactic radiotherapy (SRT) in the treatment of cervical paragangliomas. Against this background, the decision-making algorithm used in the treatment of carotid body tumors (CBTs) and vagal paragangliomas (VPs) was reevaluated relative to the existing literature on the topic.

Materials and methods

Retrospective study between 2000 and 2012. A total of 27 CBTs and nine VPs in 32 patients were treated. Shamblin class I: 59.3% (n = 16); class II: 29.6% (n = 8); class III: 11.1% (n = 3). Treatment modalities were surgery, radiotherapy, or observation. The end points for analysis were long-term tumor control and integrity of the cranial nerves.

Results

21 CBTs and seven VPs underwent surgery; SRT was performed in three CBTs and two VPs. Three CBTs were clinically observed. Permanent nerve paresis followed after surgery for CBTs in five patients (20%) and in all patients with VPs. No impaired cranial nerve function resulted after SRT. The median follow-up period was 4.7 years. The tumor control rate after therapy for CBTs and VPs was 100%. One CBT that received clinical observation showed slow tumor progression.

Conclusions

A surgical procedure should be regarded as the treatment of choice in patients with small CBTs. In larger CBTs, particularly in elderly patients with unimpaired cranial nerves, radical surgery should be regarded critically. As surgery for VPs caused regularly impairment of cranial nerves with functional disturbances of various degrees a comprehensive consultation with the patient is mandatory and nonsurgical strategies should be discussed.     

Sensitivity of the neuromagnetic N100m deflection to spectral bandwidth: a function of the auditory periphery?

The amplitude of the auditory evoked field (AEF) component N100m in response to tonal stimuli of varying spectral bandwidth and periodicity was compared with simulated peripheral activity patterns of the auditory nerve (AN). The AEF of ten subjects was recorded with a 37-channel axial gradiometer system (four independent measurement sessions per hemisphere). The simulated peripheral activity was characterized using measures derived from spike probabilities of the AN. Stimuli were pure tones, narrow-band harmonic complex tones (spectrum: 4-4.8 kHz), and broad-band harmonic complex tones (spectrum: 800 Hz-4.8 kHz) with periodicities of 100, 200, and 400 Hz. The intensity of all stimuli was set to 65 dB above the absolute thresholds. Both the simulated AN activity and measured cortical response amplitudes increased consistently with spectral bandwidth. This suggests that the enhanced sensitivity of the N100m amplitude to broad-band complex tones is to some extent a function of the auditory periphery.     

Endaural or postaural incision for myringoplasty: does it make a difference to the patient?

The aim of this study was to find out from patients who had undergone a myringoplasty via either an endaural or postaural approach whether or not they had experienced problems or symptoms relating to their scar, and if these differed depending on which incision had been used. A questionnaire was sent to 91 patients who had undergone myringoplasty between 18 and 62 months earlier. Thirty-four patients who had undergone previous or subsequent ear surgery were excluded. The only statistically significant difference found between groups having either a postauricular or endaural incision was in how likely others were to comment on their scar. There seem to be few long-term sequealae relating to the scar from myringoplasty. From a patient perspective, between 18 and 62 months postoperatively, there was very little difference in symptoms or problems whether or not an endaural or a postaural incision had been used for the surgery.     

Endaural or postaural incision for myringoplasty: does it make a difference to the patient?

The aim of this study was to find out from patients who had undergone a myringoplasty via either an endaural or postaural approach whether or not they had experienced problems or symptoms relating to their scar, and if these differed depending on which incision had been used. A questionnaire was sent to 91 patients who had undergone myringoplasty between 18 and 62 months earlier. Thirty‐four patients who had undergone previous or subsequent ear surgery were excluded. The only statistically significant difference found between groups having either a postauricular or endaural incision was in how likely others were to comment on their scar. There seem to be few long‐term sequealae relating to the scar from myringoplasty. From a patient perspective, between 18 and 62 months postoperatively, there was very little difference in symptoms or problems whether or not an endaural or a postaural incision had been used for the surgery.     

Lipopolysaccharide-induced nasal cytokine response: a dose–response evaluation

Information on the dose–response relationship is a prerequisite to defining the non-response threshold of exposure. We investigated whether nasal lipopolysaccharide (LPS) challenges induce an inflammatory response in a dose-dependent way. In three settings nasal lavage was performed before, and 20 min, 1, 6, 23, and 29 h after instillation of 0 μg, 10 μg, and 40 μg LPS for 10 s, in seven healthy subjects. Lavage fluids were analysed for concentrations of interleukin-6 (IL-6), IL-8, tumour necrosis factor-α (TNF-α), histamine, and albumin. Symptoms were recorded by questionnaire and spirometric lung function was assessed after each lavage. The instillation of 40 μg LPS caused a small increase in nasal symptoms. TNF-α was below the detection limit (0.5 pg/ml) in most subjects and, like IL-8 and albumin, showed no relation to the LPS challenge. IL-6 increased over twofold with 10 μg LPS and over 13-fold with 40 μg LPS, with a peak at 6 h after LPS provocation, and the repeated design ANOVA was significant for dose and for time. Six hours after the 40 μg LPS challenge the histamine level significantly increased compared to the saline treatment. We conclude that short-lasting instillation of LPS causes a dose-dependent IL-6 release in the upper airways and minor nasal symptoms. Received: 28 December 2000 / Accepted: 7 September 2000     

Deafblindness: a challenge for assessment--is the ICF a useful tool?

The International Classification of Functioning, Disability and Health (ICF) is considered to be a big step forward in relation to the possibilities for describing disabilities. The aim of this paper is to highlight some strengths and limitations in the ICF that have been found during a study of people with deafblindness. Thirty-two adults aged 19-92 years, totally deaf and blind, as well as those with some remaining vision and hearing, were included. Questionnaires and personal interviews were used. The participants had difficulties in activities and participation on almost all investigated items. The following five circumstances could not be taken account of: fast variation in functioning due to different personal and environmental factors; choosing not to do an activity because of a health condition; time loss impacting on quality of life; health risks related to particular impairments; and obligations. The ICF needs to address these questions and needs to be further developed.     

Is the digit triplet test an effective and acceptable way to assess speech recognition in adults using cochlear implants in a home environment?

Objectives: To evaluate the validity of the Digit Triplet Test (DTT) in a simulated home environment for measuring speech recognition in adults with cochlear implants by comparing the result to clinic speech perception tests. To evaluate the acceptability of the DTT in adults using cochlear implants.

Methods: A prospective single-centre study with the following outcomes:

??DTT Speech Reception Threshold

??Clinic speech perception tests (BKB sentences in quiet and noise, City University of New York sentences with lip-reading)

??A satisfaction questionnaire to assess patient perception of the DTT

Sixteen people using cochlear implants aged from 43 to 83 years took part.

Results: ??Eighty-eight percent of participants were able to be tested on the DTT; there were no floor or ceiling effects.

??DTT SRT was highly correlated with clinic BKB sentence scores in quiet and adaptive noise, and participants felt positive about using the DTT for home testing.

Conclusion: The majority of adults using cochlear implants in this study were able and willing to use the DTT to test their speech recognition in a simulated home environment. The DTT SRT was highly correlated with traditional clinic sentence scores, supporting its validity as a home test for hearing in adults using cochlear implants. Hearing testing in the clinic is still the gold standard of clinical care for people with cochlear implants, but a home test could provide a useful addition.     

Pulsed magnetic-field therapy: a new concept to treat tinnitus?

Both clinical and neurophysiological data suggest that chronic tinnitus is characterized by focal brain activation. In the study reported here, pulsed magnetic-field therapy induced a highly significant increase of average total power for the delta, theta, and alpha frequency bands, predominantly within the frontal regions of the brain. We conclude that pulsed magnetic-field therapy induces changes of the electroencephalography pattern that correlated with a decrease in tinnitus symptoms.     

Teratoma of the middle ear: a real entity or a non-entity?

Space-occupying lesions of the middle ear range from wholly benign developmental anomalies to highly virulent and aggressive malignancies. Amongst the benign entities classed with the family of developmental anomalies, the middle ear choristoma is well known. But what of the middle ear teratoma? Recent reports suggest that, while rare, teratomas of the middle ear do exist. Middle ear teratomas are defined as tumors consisting of benign tissues derived from all three embryologic layers: endoderm, mesoderm and ectoderm. They are lesions of the neonatal period and early infancy. While complete surgical excision will be curative, a thorough histologic examination of the specimen is recommended to exclude the possibility of immature and/or frankly malignant elements being admixed with the benign teratomatous elements.     

Can cochlear function be preserved after a modified translabyrinthine approach to eradicate a huge cholesteatoma extending to the petrous apex?

The objective of the present study was to show that the modified translabyrinthine approach with partial ablation of the labyrinths is useful for preserving hearing in our experience involving three clinical cases with huge cholesteatomas extending to the petrous apex. A retrospective analysis of patient medical records was done in a tertiary referral medical center. All three patients studied had huge cholesteatomas extending to the petrous apex and were treated surgically with a modified translabyrinthine approach between October 2005 and December 2006. The modified translabyrinthine approach was used in all patients. Long-term hearing results were obtained. The cholesteatoma sac was removed completely in all patients. Pure tone audiometry demonstrated that the hearing had been saved in two patients. We concluded that the modified translabyrinthine approach is useful for preserving hearing postoperatively when a huge cholesteatoma exists involving the petrous region or a vestibular schwannoma in the internal auditory canal or cerebellopontine angle.