Sleep-disordered breathing in the otorhinolaryngological practice.

Sleep-disordered breathing (SDB) is a common disorder in childhood. Snoring and obstructive sleep apnea represents a demanding challenge for both paediatricians and otolaryngologists. This real-life study investigated the association of demographic and clinical factors on snoring and sleep apnea in children consecutively visited. In this study, 1,002 children (550 males, mean age 5.77 + 1.84 years), complaining upper airway symptoms, were prospectively enrolled during 2015-2017. Medical history, clinical examination, and fiberoptic nasopharyngoscopy were performed in all children. Tonsil hypertrophy significantly predicted sleep apnea (OR 95.08) and snoring (OR 5.44). Asthma comorbidity significantly predicted snoring (OR 2.26). Breastfeeding could be a protective factor for sleep apnea (OR =0.37). SDB is a frequent disorder observable in otorhinolaryngological practice. Tonsil hypertrophy and asthma could be considered predicting factors for both snoring and sleep apnea, whereas breastfeeding was a protective factor for SDB.

Effect of repetition of Semont's manoeuvre on benign paroxysmal positional vertigo of posterior semicircular canal.

If Semont's liberating manoeuvre does not lead to relief of symptoms in benign paroxysmal positional vertigo of posterior semicircular canal after the first session, it can be repeated once again, in refractory cases, whilst symptomatic patients after second manoeuvre require rehabilitation therapy Repeating Semont's manoeuvre several times has proven to progressively increase the percentage of cured patients or it may convert posterior semicircular canal forms to typical incomplete or lateral semicircular canal forms, hence requiring other manoeuvres to achieve vertigo resolution. Aim of study was to assess the effect of liberating manoeuvres repeated up to 4 times and to establish possible passages from one canal to the other during manoeuvres as well as percentage of cases refractory to this therapy, who would then need rehabilitation. Benign paroxysmal positional vertigo was diagnosed in 448 cases of whom 344 (76.8%) of the posterior semicircular canal, 20 (0.45%) the incomplete form of the posterior semicircular canal, 20 (0.45%) subjective positional vertigo and 74 of the lateral semicircular canal (4.2%). Right side was affected in 58.4% of cases, left in 34.5%, and bilateral in 7.1%. All 344 patients underwent Semont's liberating manoeuvre (1st manoeuvre) with first control after 48 hours: if symptoms (typical, atypical nystagmus or paroxysmal vertigo evoked by Dix-Hallpike's manoeuvre) persisted, Semont's liberating manoeuvre was repeated (2nd manoeuvre). In presence of lateral semicircular canal benign paroxysmal positional vertigo conversion, Lempert's manoeuvre was performed instead. Second control was performed after 48 hours and in cases of persistent typical, atypical or lateral semicircular canal nystagmus 3rd manoeuvre was performed. After further 48 hours, third control was carried out: symptomatic patients with typical forms were submitted to 4th manoeuvre, while typical incomplete forms or forms of the lateral semicircular canal underwent Lempert's manoeuvre. In conclusion, symptoms disappeared after 1st manoeuvre in 61.6% of cases; further manoeuvres, carried out in view of possible changes in semeiology of vertigo, increased the percentage of cured patients to 82.5% after the 2nd, 90.7% after 3rd and 94.1% after the 4th. Repeated positioning manoeuvres in benign paroxysmal positional vertigo led to a progressive increase in percentage of cured vertigo, at the same time, allowing detection of those cases converted to multicanal pathology, hence offering the possibility to proceed with appropriate liberating manoeuvres.

[Combined genioglossus advancement (ACMG): inferior sagittal mandibular osteotomy with genioglossus advancement and stabilization with suture in patients with OSAS. Preliminary clinical results]. / Avanzamento combinato del muscolo genioglosso (ACMG): osteotomia infero-sagittale mandibolare con avanzamento muscolo genioglosso e sua stabilizzazione con sutura in pazienti con OSAS. Risultati clinici preliminari.

Surgical treatment of obstructive sleep apnea syndrome (OSAS) centres on the identification of the level of obstruction of the upper airway and the choice of the most suitable procedure to correct it. Shaping of the retrolingual hypopharyngeal space is among the most difficult to achieve because it stems from an alteration of the soft tissue of the tongue, from the hypopharynx, and is correlated to the contraction pattern of the genioglossus and the pharyngeal constrictors. We propose a surgical technique of combined genioglossus advancement (CGA) in cases of anteroposterior collapse of the retrolingual airway. Four patients affected by OSAS (RDI average = 22 events/hour), evaluated as type III obstruction in the Fujita classification, presenting the indications for surgical management of retrolingual hypopharingeal obstruction, underwent treatment. They were studied by means of a guided medical history, fiberopy endoscopy evaluation and Muller maneuver, cephalometry, endocrine tests, pneumological examinations and polysomnography. The technique proposed consists in the advancement of the genioglossus muscle by means of a bone screw on the mandibular symphysis, according to the method described by Powell, associated with the stabilization of the base of the tongue with a suspension suture, following the technique originally described by the Author and DeRowe, but without using the Repose kit. This technique makes it possible to access the retrolingual site of obstruction more effectively, more economically and with no increase in morbidity when compared with the individual techniques. In all of the patients, the only complaints regarded dysaesthesia in the area of the lower lip innerved by the mental nerve for 2-5 weeks and moderate odynophagia for 2-3 weeks; there were no haemorrhages or infections. Deglutition of fluids and solids was resumed on the 3rd post-operative day. Polysomnography after 6 months documented three positive results and one partial result, on the basis of Sher's criteria. In conclusion, the CGA technique calls for advancement of the genioglossus insertion tubercle and stabilization of the tongue to be carried out at the same time, without using the Repose kit. The CGA technique is minimally invasive and does not involve cutaneous incisions, making it a therapeutic strategy which may be inserted in a multilevel protocol excluding transcutaneous access. It is therefore proposed for type III or type IIb cases in the Fujita classification.