Assessing the need for adenotonsillectomy for sleep-disordered breathing in a community setting: A secondary outcome measures analysis of a randomized controlled study.

OBJECTIVE: To assess whether children with sleep-disordered breathing (SDB) symptom severity above a certain level, measured by a validated questionnaire, improve after adenotonsillectomy (AT) compared to no intervention. METHODS: Children with snoring and tonsillar hypertrophy (4 to 10-years old), who were candidates for AT, were randomly assigned to two evaluation sequences (baseline and 3-month follow-up): (a) evaluation immediately before AT and at 3 months postoperatively (AT group); or (b) evaluation at the initial visit and at the end of the usual 3-month waiting period for surgery (control group). Outcomes were (a) Pediatric Sleep Questionnaire sleep-related breathing disorder scale (PSQ-SRBD); (b) modified Epworth Sleepiness Scale (mESS); and (c) proportion of subjects achieving PSQ-SRBD <0.33 (low-risk for apnea-hypopnea index ≥5/h) if they had score ≥0.33 at baseline. RESULTS: Sixty-eight children were assigned to the AT and 72 to the control group and two-thirds of them had PSQ-SRBD ≥0.33. The AT group experienced significantly larger improvement between follow-up and baseline than controls (between-group difference [95% CI] for PSQ-SRBD: -0.31 [-0.35 to -0.27]; and mESS: -2.76 [-3.63 to -1.90]; P < .001 for both). Children with baseline PSQ-SRBD ≥0.33 in the AT group had an eight-times higher probability of achieving PSQ-SRBD <0.33 at follow-up than controls with similar baseline score (risk ratio [95% CI]: 8.33 [3.92-17.54]; P < .001). CONCLUSION: Among children with snoring, tonsillar hypertrophy, and clinical indications for AT, those with preoperative PSQ-SRBD score ≥0.33 show measurable clinical benefit postoperatively.

Use of Oximetry to Determine Need for Adenotonsillectomy for Sleep-Disordered Breathing.

: media-1vid110.1542/5802711151001PEDS-VA_2017-3382Video Abstract OBJECTIVES: We evaluated the efficacy of adenotonsillectomy (T/A) in children with sleep-disordered breathing (SDB) in a controlled study using oximetry. We hypothesized that children with SDB and abnormal nocturnal oximetry in a community setting will have improved hypoxemia indices after T/A. METHODS: Children with snoring and tonsillar hypertrophy (4-10 years old) who were candidates for T/A were randomly assigned to 2 oximetry sequences (baseline and 3-month follow-up): (1) oximetry immediately before T/A and at the 3-month follow-up, which occurred postoperatively (T/A group); or (2) oximetry at the initial visit and at the end of the usual 3-month waiting period for surgery (control group). Outcomes were (1) proportion of subjects with McGill oximetry score (MOS) >1 at baseline acquiring MOS of 1 at follow-up and (2) proportion of subjects achieving oxygen desaturation (≥3%) of hemoglobin index (ODI3) <2 episodes per hour at follow-up if they had ODI3 ≥3.5 episodes per hour at baseline. RESULTS: One hundred and forty children had quality oximetry tracings. Twelve of 17 (70.6%) children with MOS >1 in the T/A group and 10 of 21 (47.6%) children with MOS >1 in the control group had MOS of 1 at follow-up (P = .14). More subjects in the T/A than in the control group achieved ODI3 <2 episodes per hour at follow-up (14 of 32 [43.8%] vs 2 of 38 [5.3%]; P < .001). Three children with elevated ODI3 were treated to prevent persistently abnormal ODI3 in 1 child at follow-up. CONCLUSIONS: An ODI3 ≥3.5 episodes per hour in nocturnal oximetry is related to increased resolution rate of nocturnal hypoxemia after T/A for SDB compared with no intervention.

Age related changes in ocular motor testing in healthy subjects.

The aim of the present study was the investigation of age influenced changes in ocular motility testing in healthy subjects. Two hundred and fifty subjects between 18 and 70 years old were enrolled in a prospective study. Study population was divided in 5 groups of 50 subjects each (group A: 18-30 years old, group B: 31-40 years old, group C: 41-50 years old, group D: 51-60 years old and group E: 61-70 years old). Ocular motility was recorded by video-oculography and age related normative data were obtained with respect to: a) gain and slow phase velocity of smooth pursuit tracking, b) latency, velocity and accuracy of saccade eye movements and c) gain and slow phase velocity of optokinetic eye movements. The influence of age on all parameters was examined by one-way ANOVA. A statistically significant difference was found in all parameters analyzed for smooth pursuit test, saccade eye movements and optokinetic eye movements in between groups. In conclusion, aging influences the majority of the parameters in ocular motility testing, carried out by means of video-oculography. Elderly healthy subjects showed a deterioration of performance in all parameters of the eye tracking tested. Age must be taken into account during interpretation of the eye tracking tests, especially in patients with central nervous system lesions.

Comparison of acoustic rhinometry and nasal inspiratory peak flow as objective tools for nasal obstruction assessment in patients with chronic rhinosinusitis.

BACKGROUND: Chronic rhinosinusitis (CRS) is a disease with increasing incidence, characterized by persistent symptoms and negative impact on patient`s quality of life. Nasal inspiratory peak flow (NIPF) and acoustic rhinometry (AR) were studied and compared as assessment tools for CRS with or without nasal polyps (NP), as well as, in follow up monitoring of conservative medical treatment. OBJECTIVES: Seventy-eight patients were prospectively studied. Objective assessment included NIPF and AR at baseline and at 4 and 8 weeks after onset medical treatment. Measurements were studied in correlation with Sinonasal Outcome Test-22 (SNOT-22) questionnaire, Visual Analogue Scale (VAS) and endoscopic appearance score (EAS). RESULTS: Both NIPF and AR improved significantly, after medical treatment. NIPF score reflected CRS symptoms` improvement according to SNOT-22 total score at the end of treatment protocol, showing moderate to strong correlation with nasal obstruction VAS grading during the treatment period. AR measures were associated with EAS in all sets of examinations and correlated moderately with VAS scoring at 8 weeks. CONCLUSION: NIPF and AR were proven to be promising methods for objective evaluation and monitoring of nasal obstruction based on different aspects of nasal physiology in patients with CRS.

SNOT-22 validation in greek patients.

BACKGROUND: Chronic rhinosinusitis (CRS) with or without nasal polyps is a frequent and significant health problem. The 22-item Sinonasal Outcome Test (SNOT-22) is a valid, disease-specific health status instrument translated into several languages. The translation into Greek has been considered essential for the individual assessment of the patients' symptoms and a reliable tool for quality of life evaluation. METHODS: Our study included 40 patients with CRS without nasal polyps and 40 healthy individuals as control group recruited from the ENT Allergy and Endoscopy Clinic of Chania General Hospital. Assessment included full ENT examination and nasal endoscopy. In the study, we compared the patients' examination and reexamination results with the results of the control group, and thus estimated test-retest reliability, internal consistency (determined by Cronbach's alpha) and validity. RESULTS: The statistical significance level calculated by the paired t test was p < 0.05 for all questions, which proves the questionnaire's consistency. The kappa value was estimated for each symptom, with an average value of 0.94. Cronbach's alpha was 0.934 in the test and 0.856 in the retest. The p value was <0.05 between both the control group and the test group and between the control group and the retest group. CONCLUSION: Our study certifies the existence of a valid, reproducible Greek version of SNOT-22, which overcomes limitations of use, allows to answer the questionnaire in Greek, and thus makes it highly recommended for Greek clinicians.

Spatial overlap of combined electroacoustic stimulation determines the electrically evoked response in the guinea pig cochlea.

HYPOTHESIS: Limiting spatial overlap between electrical stimulation (ES) and acoustical stimulation (AS) in the cochlea reduces the effects of AS on electrically evoked auditory nerve activity. BACKGROUND: Some hybrid cochlear implant systems have a regular array, whereas others have short arrays that spatially segregate ES from AS. AS settings in hybrid implants may also affect electroacoustic interaction. METHODS: ES (900 µA) was delivered in the high-frequency part of the cochlea, and the electrically evoked compound action potential (eCAP) was recorded to assess auditory nerve activity. Maximal spatial overlap of ES and AS was tested by using normal-hearing animals (NH, n = 6), whereas minimal overlap was modeled by using animals with high-frequency hearing loss (HFHL, n = 6). AS consisted of broadband (BB) or low-frequency (LF) noise (0-100 dB SPL). Effects of AS on eCAP amplitude were statistically tested using 1-sample t tests (α = 0.05). RESULTS: BB noise at 60 dB SPL significantly suppressed eCAP amplitude in NH animals but not in HFHL animals up to a 30 dB higher level. Suppression with LF noise at 60 dB SPL was not significant in either the NH or the HFHL group, but at 90 dB SPL, suppression was significant in both groups. CONCLUSION: Minimizing spatial overlap between ES and AS reduces eCAP suppression when moderate sound levels are applied. Overlap can be reduced by applying ES in an acoustically insensitive part of the cochlea or by limiting the acoustic spectrum to low frequencies when ES is applied in acoustically sensitive areas.

Clinical application of subjective measurements for OSAS assessment: predictive factors of syndrome severity.

PURPOSE OF THE STUDY: To examine the clinical value of subjective evaluations of obstructive sleep apnea syndrome (OSAS) in correlation with syndrome severity as diagnosed with polysomnography. PROCEDURES: 210 patients with mild to severe OSAS were assessed. Objective evaluation included polysomnography. Subjective assessment included full ENT examination, neck circumference (NC) plus body mass index measurements, Mueller maneuver and Epworth Symptom Scale (ESS). RESULTS: The presence of lateral pharyngeal wall movement, abnormal ESS scoring and male gender can be considered independent risk factors for the prediction of moderate/severe OSAS (p < 0.05). Increased NC can also be considered a clinical risk factor related to male gender and lateral pharyngeal wall movement (p = 0.05). CONCLUSIONS: Subjective OSAS assessment, including evaluation of lateral pharyngeal wall movement, ESS scoring and NC measurement can safely predict, mainly in males, OSAS severity, as diagnosed with polysomnography. MESSAGE OF THE PAPER: Subjective assessment from the ENT point of view should raise high suspicion towards the early diagnosis of moderate/severe OSAS.

Evaluating the outcome of phonosurgery: comparing the role of VHI and VoiSS questionnaires in the Greek language.

OBJECTIVES/HYPOTHESIS: The objective was to study the role of the Greek version of Voice Handicap Index (VHI) in comparison with Voice Symptom Scale (VoiSS) in terms of measuring voice surgery outcome in patients with benign laryngeal lesions. STUDY DESIGN: Nonrandomized prospective. METHODS: Forty-six patients operated for benign laryngeal lesions were enrolled in the present study. All patients were assessed according to the European Laryngological Society guidelines. In terms of self-evaluation, patients answered the Greek versions of both VHI and VoiSS, preoperatively and 6 weeks postoperatively, and the results were statistically analyzed. RESULTS: The strongest correlation was observed between the functional subscale of VHI and the impairment subscale of VoiSS, as well as, between the emotional subscales of both VHI and VoiSS, pre- and postoperatively. A statistically significant change in subscale and total scores was found. VHI and VoiSS subscales and total scores correlated with the stroboscopic and aerodynamic measurements in a variable manner. Perceptual measurements, as well as shimmer and harmonic-to-noise ratio showed significant correlation with both VHI and VoiSS subscale and total scores postoperatively. CONCLUSION: VHI and VoiSS are considered useful tools in evaluating voice surgery outcome, in the Greek language.

Auditory brainstem response changes during exposure to GSM-900 radiation: an experimental study.

The objective of the present study was to investigate the possible electrophysiological time-related changes in auditory pathway during mobile phone electromagnetic field exposure. Thirty healthy rabbits were enrolled in an experimental study of exposure to GSM-900 radiation for 60 min and auditory brainstem responses (ABRs) were recorded at regular time-intervals during exposure. The study subjects were radiated via an adjustable power and frequency radio transmitter for GSM-900 mobile phone emission simulation, designed and manufactured according to the needs of the experiment. The mean absolute latency of waves III-V showed a statistically significant delay (p < 0.05) after 60, 45 and 15 min of exposure to electromagnetic radiation of 900 MHz, respectively. Interwave latency I-III was found to be prolonged after 60 min of radiation exposure in correspondence to wave III absolute latency delay. Interwave latencies I-V and III-V were found with a statistically significant delay (p < 0.05) after 30 min of radiation. No statistically significant delay was found for the same ABR parameters in recordings from the ear contralateral to the radiation source at 60 min radiation exposure compared with baseline ABR. The ABR measurements returned to baseline recordings 24 h after the exposure to electromagnetic radiation of 900 MHz. The prolongation of interval latencies I-V and III-V indicates that exposure to electromagnetic fields emitted by mobile phone can affect the normal electrophysiological activity of the auditory system, and these findings fit the pattern of general responses to a stressor.

Subcutaneus leiomyosarcoma of the neck: a case report.

INTRODUCTION: Leiomyosarcomas are rare tumors. The most common site for head and neck leiomyosarcomas is the oral cavity, followed by sinonasal tract and skin. Subcutaneous leiomyosarcomas are thought to arise from small to medium-sized blood vessels in the subcutaneous tissue. CASE PRESENTATION: A 67-year-old female patient underwent excision of a slow growing neck mass of the left posterior neck triangle after a thorough clinical and laboratory examination. The lesion was located in the subcutis and fine needle aspiration biopsy revealed malignant features. Histology revealed subcutaneous leiomyosarcoma and the patient is free from local recurrence and distant metastases 3 years after wide excision of the lesion. CONCLUSIONS: The primary modality of therapy of subcutaneous leiomyosarcoma is surgery, adjuvant radiotherapy or chemotherapy may be used for control of local recurrence, in case of positive surgical margins, high-grade or large tumors.

Brown tumor of the maxillary sinus in a patient with primary hyperparathyroidism: a case report.

INTRODUCTION: Brown tumors are rare focal giant-cell lesions that arise as a direct result of the effect of parathyroid hormone on bone tissue in some patients with hyperparathyroidism. Brown tumors can affect the mandible, maxilla, clavicle, ribs, and pelvic bones. Therefore, diagnosis requires a systemic investigation for lesion differentiation. CASE PRESENTATION: We present a 42-year-old Greek woman, with a rare case of brown tumor of the maxillary sinus due to primary hyperparathyroidism. Primary hyperparathyroidism is caused by a solitary adenoma in 80% of cases and by glandular hyperplasia in 20%. CONCLUSIONS: Differential diagnosis is important for the right treatment choice. It should exclude other giant cell lesions that affect the maxillae.

Antihistamine effects on experimental middle ear inflammatory model.

Allergy is thought to be one of the etiologic factors in otitis media. The purpose of this study was to determine the histopathologic effects of H1 histamine receptor antagonists in an experimental histamine-induced middle ear inflammation model. In group A (20 rabbits), histamine challenge followed a 3-day intramuscular pretreatment with a single dose of 0.1 ml hydroxyzine hydrochloride (50 mg/ml) per day. In group B (20 rabbits), histamine challenge followed a 3-day pretreatment with a single dose 1.2 mg desloratadine per day orally. In group C (20 rabbits), histamine challenge followed a 3-day pretreatment with a single dose 1.2 mg levocetirizine per day orally. On the fourth day after baseline otomicroscopy 0.5 ml histamine 20 mg/ml was injected transtympanically on the right. Middle ear mucosa was removed and the following parameters were assessed: edema, vascular dilatation and congestion, inflammation, acute inflammatory component, presence of eosinophils, activity of the inflammation and fibrosis. A semi-quantitative grading system of 0-3 was used for grading of all parameters and statistical analysis performed by using the Mann-Whitney non-parametric test. Group A mucosae showed lower grades of all the parameters evaluated compared with those of group B. Histopathology of the mucosae of group C showed lower grade of inflammation compared with group B with significant statistical difference for the seven parameters tested. Our data validate the use of antihistamines in the treatment of refractory OME of allergic origin. Oldest H1 antagonists can be replaced by the newest agents who counteract successfully histamine effects, without any interactions or adverse effects from central nervous system.

Canal wall down mastoidectomy for cholesteatoma: experience at the University of Crete.

OBJECTIVE: To evaluate clinical and audiologic data as well as operative findings and postoperative follow-up in the management of chronic cholesteatomatous otitis media with canal wall down mastoidectomy (CWDM). STUDY DESIGN: A retrospective review of cases followed up between 1990 and 2002. SETTING: Tertiary referral centre. METHOD: Two hundred one patients with chronic otitis media with cholesteatoma underwent CWDM. MAIN OUTCOME MEASURES: Clinical presentation, surgical findings, and audiologic evaluation were assessed. RESULTS: Preoperatively, eight patients suffered from vertigo and four presented with facial nerve paralysis. In 40 patients (20%), erosion of the lateral semicircular canal was found, and in 31 patients (15%), there was dehiscence of the facial nerve canal. Dural plate erosion and sinus plate dehiscence were found in 13 and 17 patients, respectively. Nine patients experienced serious endocranial complications at their admission. The malleus was noted to be intact in the majority of patients in all age groups. The incus was eroded or absent in most of the cases in all age groups. On postoperative evaluation 3 months after surgery, 195 audiograms were performed, with a mean pure-tone average of 55 dB HL and a mean air-bone gap of 30 dB HL. CONCLUSION: Although CWDM has the disadvantages of the necessity to avoid water insertion in the external auditory canal and lifelong mastoid care, it is an effective treatment in a single-step procedure for patients with advanced disease and for those who refuse to submit to postoperative follow-up.

Malignant mixed tumor of the nasal cavity.

Parotid gland is the most common location of malignant mixed tumors. Three different subtypes of these tumors exist: carcinoma ex pleomorphic adenoma, carcinosarcoma, and metastasizing mixed tumor. Carcinoma ex-pleomorphic adenoma is by far the most common subtype. Although unusual sites of these tumors have been published, we report an extremely rare case of a malignant mixed tumor located in the nasal cavity.

Kikuchi's disease: a benign cause of fever and cervical lymphadenopathy.

Histiocytic necrotizing lymphadenitis (Kikuchi's disease, KD) is a rare benign condition of unknown origin, usually characterized by lymphadenopathy and fever, affecting mainly young women. We describe three cases of patients, one man and two women, with biopsy-proven KD detected at our university hospital during the past 3 years and we review the literature.

Arteriovenous malformation of the floor of the mouth: a case report.

Arteriovenous malformations of the head and neck are rare lesions with unclear pathogenesis. They usually present during childhood, growing proportionately to the child. Although preoperative superselective embolization followed by surgical resection is the treatment of choice, complete removal is often not feasible, leading to high recurrence rates. The case of a patient with an arteriovenous malformation of the floor of the mouth diagnosed late in her adulthood and its management are presented.

Symptomatic epilepsy due to a huge frontal sinus mucocele. A case report.

We report the case of a 57-year-old man complaining of headaches and adult onset seizures. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a process which proved to be a huge frontal sinus mucocele, eroding the posterior wall of the frontal sinus and compressing the left frontal lobe. An osteoplastic flap procedure with cranialization and obliteration of the frontal sinus was performed. The seizures and headache disappeared postoperatively. Clinical manifestations, diagnosis and surgical approaches for grand frontal sinus mucoceles are briefly discussed.

Laser-assisted uvulopalatoplasty for the treatment of snoring and mild obstructive sleep apnea syndrome.

OBJECTIVE: To determine the efficacy of the laser-assisted uvulopalatoplasty (LAUP) procedure on snoring and Apnea-Hypopnea-Index (AHI) improvement in patients with snoring and mild obstructive sleep apnea syndrome (OSAS). STUDY DESIGN: Prospective, nonrandomized, nonblinded assessment of outcomes after LAUP in patients suffering from benign habitual snoring and/or mild OSAS. METHODS: Fifty-nine patients with habitual snoring and 25 patients with mild OSAS underwent LAUP (6 of them underwent simultaneous classic tonsillectomy and 20 carbon-dioxide laser tonsillotomy). All patients and their bed partners completed pre- and post-treatment questionnaires ranking snoring, whereas the patients with mild OSAS underwent postoperative polysomnography (PSG). RESULTS: During a 6-month to 5-year follow-up (mean 40 months), 91.5% of the patients with habitual snoring reported significant short-term improvement based on post-treatment questionnaires, whereas 79.7% reported long-term subjective improvement. Nineteen of 25 patients (76%) with mild OSAS reported significant improvement of snoring based on posttreatment questionnaires. According to the postoperative PSG, only 2% showed a worse AHI, whereas 60% showed reduction of the AHI to < or = 5. Eight patients (32%) showed little or no improvement of AHI. CONCLUSIONS: LAUP, in combination with carbon-dioxide laser tonsillotomy in some cases, is a safe, cost-effective, outpatient procedure for the treatment of many cases of habitual snoring and mild OSAS when preceded by careful selection of the candidates.

Cochlear implantation after radical mastoidectomy: management of a challenging case.

Due to increasing experience and technological improvement, the selection criteria for cochlear implantation have improved. Cochlear implant application can now be performed in selected patients with pathological middle ear lesions. The surgical approach to a patient with a history of bilateral radical mastoidectomy is addressed in detail. The benefits of cochlear implantation in this case are also discussed.