Is obstructive sleep apnea syndrome a risk factor for auditory pathway?

PURPOSE: The transduction mechanism of the inner ear and the transmission of nerve impulses along the auditory way are highly dependent upon the cochlear oxygen supply. Several studies have considered the possibility that obstructive sleep apnea-hypopneas during sleep can interfere with these processes, and the results are not uniform. The aim of the study is to evaluate the auditory function in adult patients affected by severe obstructive sleep apnea syndrome (OSAS). METHODS: Thirty-nine patients in this study were included and divided in OSAS group, with severe OSAS (Apnea-Hypopnea Index, AHI > 30), and control group with snoring without OSAS (AHI < 5). Each patient was subjected to pure-tone audiogram (PTA), otoacoustic emission (OAE), and brainstem auditory evoked potentials. RESULTS: The OSAS group showed a PTA significantly higher than the control group (14.23 ± 6.25 vs. 7.45 ± 2.54; p < 0.01), a lower TEOAE reproducibility (0.57 ± 0.10 vs. 0.92 ± 0.10; p < 0.01) such as a lower signal-to-noise 0atio (p < 0,01) and a lower DPOAE amplitude (5.96 ± 6.34; 13.18 ± 2.97; p < 0.01). The mean latencies of waves I, III, and V were prolonged in OSAS group as compared to the healthy people, especially for wave V (p < 0.05). The interpeak latency (IPL) of I-V was significantly higher (p < 0.01) in the OSAS patients (5.84 ± 0.15) as compared to the control group (5.4 ± 0.12), such as IPLs I-III and III-V (p < 0.05). CONCLUSIONS: Our data showed an auditory dysfunction in patients affected by severe OSAS, suggesting that severe OSAS could represent a risk factor for auditory pathway.

Facial nerve outcome after vestibular schwannoma surgery: our experience.

In this study we evaluate the postoperative facial nerve function after vestibular schwannoma (VS) surgery and analyze the factors that cause it. We included 97 consecutive patients undergoing surgical excision of sporadic unilateral VS. Patient and tumor characteristics, surgical approaches, facial nerve function, extent of tumor removal, perioperative complications are all analyzed through standardized systems. Four different surgical approaches are used: translabyrinthine, retrolabyrinthine, retrosigmoid, and middle cranial fossa. Anatomic preservation of the facial nerve is achieved in 97% of patients. The incidence of postoperative facial palsy is found to be statistically correlated to tumor size, but not to the surgical approach used and to extent of tumor penetration in the internal auditory canal. A significant improvement of the short-term facial nerve outcome is detected in patients undergone simultaneous intraoperative electromyography (EMG) and pneumatic facial nerve monitoring. Complete tumor excision is achieved in 94% of cases. Complication rates are excellent and no deaths are reported. Short- and long-term facial nerve outcome is good and comparable with those of other series reported in literature. In VS surgery both EMG and pneumatic facial nerve monitors should be simultaneously used. Further investigations are desirable to improve the facial outcome respecting the oncological radicality.

Nasal polyposis: from pathogenesis to treatment, an update.

Nasal polyps (NP) are common benign degeneration of nasal sinus mucosa with a prevalence around 4% in the adult population. The causes are still uncertain but there is a strong association with allergy, infection, asthma and aspirin sensitivity. Histologically, the presence of a large quantity of extracellular fluid, mast cell degranulation and eosinophilia has been demonstrated. Typically the patients show nasal obstruction, anosmia and rhinorrhoea. Nasal endoscopic examination and CT imaging allow evaluation of the disease extension. A combined medical and surgical treatment is recommended for symptoms control in preventing symptomatic NP recurrence. We will review the current knowledge in the pathogenesis and treatment of this complex disease entity.