Congenital laryngomalacia: Is it an inflammatory disease? The role of vitamin D.

OBJECTIVES/HYPOTHESIS: Laryngomalacia is the most common cause of stridor in infants. The exact pathophysiology is still not well understood. Our objective was to investigate whether laryngomalacia is an inflammatory disease, focusing on the possible role of vitamin D. STUDY DESIGN: Case-control study. METHODS: Sixty Egyptian infants and 60 mothers were included in this study. They were divided into four equal groups (n = 30 for each): infants with laryngomalacia (LM-infants), control infants (C-infants), mothers of the infants with laryngomalacia (LM-mothers), and mothers of the control infants (C-mothers). Laryngoscopy was performed and serum 25-hydroxyvitamin D (25[OH]-vitamin-D) and interleukin 6 (IL-6) were estimated. RESULTS: Significant increase of serum IL-6 associated with a significant decrease in serum 25(OH)-vitamin D was observed in the LM-infants compared to the C-infants (P < .001 for both). LM-mothers had significantly lower 25(OH)-vitamin D status compared to C-mothers (P < .001). CONCLUSIONS: Deficiency of 25(OH)-vitamin D in LM-infants may result in dysregulation of the immune responses with elevation of a proinflammatory cytokine (IL-6). Laryngomalacia could be an inflammatory disease due to 25(OH)-vitamin D deficiency as evidenced by the high level of IL-6. This finding may open the door to the appropriate prevention, diagnosis, and treatment, especially for moderate to severe laryngomalacia. LEVEL OF EVIDENCE: 3b Laryngoscope, 130:448-453, 2020.

Gender differences in morphological and functional outcomes after mandibular setback surgery.

PURPOSE: The aim of this study was to examine and compare morphological and functional outcomes after either isolated mandibular setback or bimaxillary surgery in males and females. MATERIALS AND METHODS: A retrospective study was done on 52 patients, in whom surgical correction for mandibular prognathism was performed either by isolated mandibular setback (30 cases) or by bimaxillary surgery (22 cases). Morphological changes were studied using cephalograms and functional changes studied using impulse oscillometry (IOS) taken before surgery (T0), 3 months (T1) and 1 year after surgery (T2). Also 3% oxygen desaturation index (ODI) was measured at T0 and T2. RESULT: Posterior airway space decreased significantly in both groups and both sexes but more so in males after mandibular setback surgery and in females after bimaxillary surgery. Changes in supine R20 (central airway resistance at 20 Hz) and supine R5 (total airway resistance at 5 Hz) in IOS statistically significantly increased in the period T0-T1 in males compared with females after mandibular setback surgery (p < 0.05). CONCLUSION: Gender dimorphism is present according to morphological and functional outcomes, with males at a higher risk for obstructive sleep apnea (OSA) after mandibular setback surgery and females after bimaxillary surgery; however, compensatory changes act as a barrier against this.

The Relationship Between Cephalogram Analysis and Oxygen Desaturation Index During Sleep in Patients Submitted for Mandibular Setback Surgery.

OBJECTIVES: The aim of this study was to examine the relationship between morphologic factors of mandibular protrusion patients and clinical indices of obstructive sleep apnea (OSA). METHODS: Fifty-two Japanese patients divided into 2 groups: 1 jaw surgery group (30 patients) and 2 jaw surgery group (22 patients). Morphologic changes were studied using cephalograms taken before surgery and 1 year after surgery. Functional changes studied using impulse oscillometry and pulse oximetry during sleep, both of which are clinically useful measures in assessing OSA, taken before surgery and 1 year after surgery. RESULT: Lower face cage area significantly decreased in 1 jaw group than in 2 jaw group patients. Positive significant correlation was found between changes in 3% oxygen desaturation index (ODI) and changes of tongue area and vertical position of the hyoid bone in 1 jaw surgery group. Multiple regression analysis indicates that tongue area and airway area were independently significant predictors of 3% ODI in 1 jaw group patients. CONCLUSION: In 2 jaw surgery, maxillary surgery compensated for the effect of mandibular setback surgery. Mandibular setback surgery to mandibular protrusion patients was performed within the range of adequate movement distance, but precautions for risk of postoperative obstructive sleep apnea syndrome should be considered.

Is insufficient pulmonary air support the cause of dysphonia in chronic obstructive pulmonary disease?

OBJECTIVE: Optimal pulmonary air support is essential pre-requisite for efficient phonation. The objective is to correlate pulmonary and vocal functions in chronic obstructive pulmonary disease (COPD) to find out whether the reduced pulmonary function per se could induce dysphonia. METHODS: In this prospective case-control study, sixty subjects with stable COPD underwent evaluation of pulmonary and vocal functions. The pulmonary functions measured include {Forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC ratio, peak expiratory flow (PEF), maximum mid-expiratory flow (MMEF)}. The vocal functions were {jitter, shimmer, noise-to-harmonic ratio, pitch perturbation quotient, amplitude perturbation quotient, maximum phonation time (MPT), sound pressure level, phonatory efficiency, resistance and power. A control group (n=35) underwent the same measurements. These functions were compared between subjects and controls. Also, correlation of the vocal and pulmonary functions was conducted. RESULTS: Thirty five (58.3%) of COPD subjects have dysphonia. The pulmonary functions were lower in all COPD group than in the control group (P<0.001 for all parameters). Also, the FVC, FEV1, PEF and MMEF % of predicted values were significantly lower in subjects with dysphonia (n=35) than those without dysphonia (n=25) with P values 0.0018, <0.001, 0.0011 and 0.0026 respectively. In addition, the MPT in all subjects showed positive correlations to the 5 pulmonary functions (P=0.004 for FEV1/FVC ratio and P<0.001 for the rest). Also, the phonatory efficiency showed significant positive correlations with the pulmonary functions FVC, FEV1, PEF and MMEF (P=0.001, 0.001, 0.002 and 0.001 respectively). Unlike efficiency, the phonatory resistance revealed significant negative correlations with these pulmonary functions in the same order (P=0.001, 0.003, 0.002, 0.001 respectively). CONCLUSION: Dysphonia is a common comorbidity with COPD which attributed to multifactorial etiologies. The lower the pulmonary function in COPD patients is the more likely to have dysphonia. Decreased pulmonary function was associated with reduced MPT and phonatory efficiency but with increased phonatory resistance. The reduced pulmonary functions in COPD can be the underlying cause of the altered vocal function and dysphonia. Great part of this dysphonia is functional, and hence, can be corrected by voice therapy in compensated subjects. Further researches are needed to evaluate the efficacy of voice therapy in these patients.

Closure of fistula of the hard palate with two layers of mucoperiosteum.

OBJECTIVE: Oronasal fistula represents a functional problem, as it may result in nasal regurgitation of food and fluids and it also leads to hypernasal speech. Many methods have been proposed for its closure with a high recurrence rate. The aim of this study was to assess the efficacy of closure of hard palate fistula by two layers of mucoperiosteal flaps. METHODS: Eighteen patients with fistula of the hard palate were included. The fistula was repaired by two layers of mucoperiosteal flaps; the first layer was created from the mucoperiosteum surrounding the fistula as bilateral hinge flaps and the second layer was formed of a rotational flap based on the greater palatine artery. Pre- and postoperative clinical assessment was performed. RESULTS: The etiology of fistulas was previous cleft palate repair in 13 patients, previous nasal septal surgery in 3 patients, and untreated sharp accidental trauma to the palate in 2 patients. All patients presented with nasal regurgitation and hypernasal speech. Complete closure of all fistulas was achieved at first attempt, with no recurrence through the follow up period. CONCLUSIONS: Closure of oronasal fistula by two layers of mucoperiosteal flaps is an effective method and it has neither complications nor recurrence.

Impact of cartilage graft size on success of tympanoplasty / Impacto do tamanho do enxerto de cartilagem no sucesso da timpanoplastia

Abstract Introduction: In the last decade, there has been an increasing use of cartilage grafts in the primary repair of tympanic membrane perforations. The major advantages of cartilage are its stiffness and its very low metabolic requirements, which make it particularly suitable for difficult conditions, such as subtotal perforations, adhesive otitis and reoperation. Objective: To analyze the impact of different perforation sizes requiring different sizes of cartilage on the anatomical and functional outcome after tympanoplasty. Methods: Through this prospective non-controlled, non-randomized study, 50 patients underwent cartilage type 1 tympanoplasty (20 females and 30 males), with a mean age of 19.3 ± 9.8 years. According to size of perforation, patients were subdivided into three groups, Group I had perforation >50% of tympanic membrane area, in Group II patients the perforations were 25-50% of tympanic membrane area, and in Group III the perforations were ≤25% of tympanic membrane. All patients had pre and postoperative Pure Tone Average and Air Bone Gap frequencies (0.5, 1, 2, 4 kHz). All patients were followed up at least 12 months after operation. Results: The anatomical success rate among all patients was 92%, all groups showed statistical significant improvement between pre and postoperative air bone gap, no significant correlation between size of cartilage graft and degree of air bone gap improvement was noticed among the three groups. Conclusion: Size of a cartilage graft has no impact on degree of hearing improvement or anatomical success rate after tympanoplasty.

Resumo Introdução: Na última década, tem havido um interesse crescente no uso de enxertos de cartilagem como opção para o reparo de perfurações primárias de membrana timpânica. As principais vantagens da cartilagem são a sua rigidez e o metabolismo braditrófico, o que a torna particularmente adequada para condições difíceis, tais como perfurações subtotais, otite adesiva e reoperações. Objetivo: Analisar o impacto de diferentes tamanhos de perfuração, portanto diferentes tamanhos de cartilagem, sobre o desfecho anatômico e funcional da timpanoplastia. Método: Através deste estudo prospectivo, não controlado, não randomizado, 50 pacientes foram submetidos a timpanoplastia de cartilagem tipo 1 (20 mulheres e 30 homens), com idade média de 19,3 ± 9,8 anos. De acordo com o tamanho da perfuração, os pacientes foram subdivididos em três grupos, Grupo I com perfuração > 50% da área da membrana timpânica, Grupo II com perfuração de 25%-50% da área da membrana timpânica, Grupo III com perfuração ≤ 25% da membrana timpânica. Todos apresentavam Audiometria tonal pura pré e pós-operatório - gap Aéreo-Ósseo para frequências testadas (0,5, 1, 2, 4 kHz). Todos os pacientes foram acompanhados por pelo menos 12 meses após a cirurgia. Resultados: A taxa de sucesso anatômico entre todos os pacientes foi de 92%, todos os grupos apresentaram melhoria estatisticamente significante entre pré e pós-operatório nos três grupos, não houve correlação significante entre o tamanho do enxerto de cartilagem e observou-se algum grau de melhoria do gap nos 3 grupos. Conclusão: O tamanho do enxerto de cartilagem não tem impacto sobre o grau de melhoria da audição ou na taxa de sucesso anatômico após timpanoplastia.

Impact of cartilage graft size on success of tympanoplasty.

INTRODUCTION: In the last decade, there has been an increasing use of cartilage grafts in the primary repair of tympanic membrane perforations. The major advantages of cartilage are its stiffness and its very low metabolic requirements, which make it particularly suitable for difficult conditions, such as subtotal perforations, adhesive otitis and reoperation. OBJECTIVE: To analyze the impact of different perforation sizes requiring different sizes of cartilage on the anatomical and functional outcome after tympanoplasty. METHODS: Through this prospective non-controlled, non-randomized study, 50 patients underwent cartilage type 1 tympanoplasty (20 females and 30 males), with a mean age of 19.3±9.8 years. According to size of perforation, patients were subdivided into three groups, Group I had perforation >50% of tympanic membrane area, in Group II patients the perforations were 25-50% of tympanic membrane area, and in Group III the perforations were ≤25% of tympanic membrane. All patients had pre and postoperative Pure Tone Average and Air Bone Gap frequencies (0.5, 1, 2, 4kHz). All patients were followed up at least 12 months after operation. RESULTS: The anatomical success rate among all patients was 92%, all groups showed statistical significant improvement between pre and postoperative air bone gap, no significant correlation between size of cartilage graft and degree of air bone gap improvement was noticed among the three groups. CONCLUSION: Size of a cartilage graft has no impact on degree of hearing improvement or anatomical success rate after tympanoplasty.