Mandibular advancement devices vs nasal-continuous positive airway pressure in the treatment of obstructive sleep apnoea. Systematic review and meta-analysis

Obstructive sleep apnoea (OSA) is a common disorder that may affect at least 2 to 4% of the adult population. Nasal-Continuous Positive Airway Pressure (N-CPAP) is today considered the gold standard for the treatment of OSA. The development of oral appliances (OAs) represents a new approach for the management of this pathology. The aim of this systematic review is to compare the efficacy of OAs and N-CPAP in the treatment of patients with mild to severe OSA. A PubMed-MEDLINE and Cochrane databases search of articles published between 1982 and 2016 comparing the effect of N-CPAP and OAs in OSA patients was conducted during July 2016. The studies were selected and stratified according to PRISMA and SORT criteria. The main outcome measure was post-treatment Apnoea-Hypopnoea Index (AHI) while secondary outcomes included post-treatment Epworth Score Scale (ESS) score and lowest Oxygen Saturation level. N-CPAP was significantly more effective in suppressing AHI than OA. Moreover, N- CPAP was significantly more effective in increasing post-treatment lowest Oxygen Saturation level than OA. However, no significant different in decreasing ESS values was found between the two treatments. On the basis of evidence in this review it would appear appropriate to offer OA therapy to those who are unwilling or unable to persist with CPAP therapy. N-CPAP still must be considered the gold standard treatment for OSA and, therefore, OAs may be included in the list of alternative options

Sonoelastography in the diagnosis of tendinopathies: An added value

BACKGROUND: sonoelastography helps in the detection of abnormalities not yet evident on B-mode exam. METHODS: in this observational study, we report a collection of cases of symptomatic patients without alterations at ultrasound imaging but with evidence of pathological findings at sonoelastography. Patients, with clinical history suggestive for tendinopathies or surgically treated, and negative at the ultrasound exam, were submitted to sonoelastography. Out of 846, 632 patients with positive ultrasound exam were excluded. Sonoelastography was therefore performed in the remaining 214. RESULTS: the examination was positive in 168 cases: 78 patients were affected with shoulder diseases, while elbow pathology was observed in 31 subjects; patellar, Achilles and plantar fascia disorders were reported in 19, 27, and 13 patients, respectively. CONCLUSION: sonoelastography can reveal tendon abnormalities of clinical relevance in a high percentage of cases, where the ultrasound exam was negative, making the method a complementary tool to ultrasound evaluation

Multidisciplinary approach in the removal of post-trauma foreign bodies in the head and neck district: Cases report and review of literature

Introduction: The management of foreign bodies (FBs) penetrating the head and neck district is a condition rare but at risk for the patient’s life because this district is particularly rich in vital structures. Therefore, their management requires a multidisciplinary approach. Materials and methods: In this study we retrospectively examine two emblematic cases among 183 that occurred in our hospital from January 2008 to December 2017. Results: There were 183 cases of FBs of the head and neck district submitted to extraction with a range of age of between 18 months old and 79 years old. Of 183 patients, 112 were children, 60 were adults. The incidence was prevalent among children, with 112 cases against 60 cases in adults (including 11 post-dental care cases). Only 2 remaining cases described are characterized by the involvement of several districts Conclusion: Both cases evidenced like as a multidisciplinary approach is important to minimize potential complications and sequelae

Ear, nose and throat (ENT) involvement in zoonotic diseases: a systematic review

INTRODUCTION: Zoonoses are infections transmitted from animal to man, either directly (through direct contact or contact with animal products) or indirectly (through an intermediate vector, such as an arthropod). The causative agents include bacteria, parasites, viruses, and fungi. The purpose of this review is to make an accurate examination of all zoonotic diseases that can be responsible of ear, nose, and throat (ENT) involvement. METHODOLOGY: A PubMed search was performed combining the terms (otorhinolaryngology OR rhinology OR laryngology OR otology OR mastoiditis OR otitis OR sinusitis OR laryngitis OR rhinitis OR pharyngitis OR epiglottitis OR dysphonia OR ear OR larynx OR nose OR pharynx) with each one of the etiological agents of zoonoses for the period between January 1997 and August 2012 without language restrictions. RESULTS: A total of 164 articles were selected and examined. Larynx was the most commonly involved ENT organ, followed by oral cavity, pharynx, and neck. Bacteria were the most representative microorganisms involved. Nose and major salivary glands were affected most frequently by protozoa; paranasal sinus, oral cavity, ear, neck, nerves and upper airway by bacteria; and larynx by fungi. CONCLUSIONS: ENT symptoms and signs may be present in many zoonotic diseases, some of which are also present in industrialized countries. Most zoonotic diseases are not commonly encountered by ENT specialists. Appreciation of the possible occurrence of these diseases is important for a correct microbiological approach, which often requires special culture media and diagnostic techniques

MALIGNANT EXTERNAL OTITIS. A CASE SERIES FROM AN ITALIAN TERTIARY-CARE HOSPITAL

Objectives: Malignant external otitis (MEO) is an. aggressive and potentially fatal disease that affects the external. auditory canal (EAC) it occurs almost exclusively in elderly, diabetic patients or immune compromised ones. The aim of this study was to describe epidemiological and clinical characteristics of a consecutive series of patients affected by malignant external otitis (MEO) and to conceive a flow-chart for its management. Material and methods: Adult patients diagnosed with and treated for MEO at the University Hospital of Messina, Italy between 2003 and 2013 were identified. Charts were reviewed for history, clinical presentation, laboratory data treatment, and outcomes. Results: Data of 11 patients were analyzed. Patients' mean age was 67.6 years; and ten were males. All but one suffered from diabetes and one was HIV infected. Average time of arrival at our department from onset of symptoms was 123 weeks. Intravenous antibiotics were administered in seven cases whereas exclusively oral antibiotics were given to four patients. Local antibiotic therapy was associated to systemic administration in seven cases. Four patients underwent surgical treatment. The median duration of antibiotic treatment was 12.4 weeks. Ten patients experienced a complete recovery even if in one of these residual facial palsy Was reported; one patient died Of a skull base Osteomyelitis with Multiple nerve involvement. A flow-chart which could guide physicians in the management of MEO is proposed. Conclusions. Malignant external otitis still remains today a very challenging issue Randomized clinical trials are needed to better clarify which Medical and surgical treatment could be the gold standard. A consensus diagnostic flow diagram could help in the management of this pathology

Direct transition from quantum escape to phase diffusion regime in YBaCuO biepitaxial Josephson Junctions

Dissipation encodes interaction of a quantum system with the environment and regulates the activation regimes of a Brownian particle. We have engineered grain boundary biepitaxial YBaCuO junctions to drive a direct transition from quantum activated running state to phase diffusion regime. The cross-over to the quantum regime is tuned by the magnetic field and dissipation is encoded in a fully consistent set of junction parameters. To unravel phase dynamics in moderately damped systems is of general interest for advances in the comprehension of retrapping phenomena and in view of quantum hybrid technology

Linear stapler closure of the pharynx in laryngectomy: our experience (endoscopic closed technique)

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Dental implants after the use of bichat’s buccal fat pad for the sealing of oro-antral communications. A case report and literature review

Oro-antral communications are frequent complications in oral surgery, and generally occur after molar extractions, maxillary sinus elevations or dental implant procedures. The presence of these defects may increase the morbidity and often need a surgical approach. The present report describes an oro-antral communication in a 52-year-old female who presented a 2 week-course of painless nasal obstruction and rhinorrea after a right maxillary sinus floor elevationwith simultaneous dental implant placement. Based on the anamnesis, clinical examination and a computed tomographyof the paranasal sinuses, a diagnosis of odontogenic rhinosinusitis associated with a 1.5 cm diameter oro-antral communicationwas establishedand its surgical closure using Bichat’s buccal fat pad was planned.After 15 months, the patient was successfully rehabilitated with an implant-supported 3 unit fixed partial denture

Vocal Tract Discomfort Scale (VTDS) and Voice Symptom Scale (VoiSS) in the Early Identification of Italian Teachers with Voice Disorders

Introduction The current Italian law does not include any guidance regarding voice education, prevention of voice disorders and screening in subjects with high vocal loading such as teachers. Objectives We aimed to check the correlation between the Vocal Tract Discomfort Scale (VTDS) with the Voice Symptom Scale (VoiSS) for the evaluation of Italian teachers. In addition, we aimed to investigate whether there are differences in the frequency and intensity of discomfort symptoms in teachers with disabilities comparing vocal tract discomfort symptoms in teachers with high risk (HRVD) and low risk (LRVD) of vocal disorders according to the VoiSS cutoff (> 15.5). Methods We analyzed 160 Italian teachers (111 women and 49 men) that completed the VTDS and VoiSS at vocal evaluation. The Spearman correlation test was applied to all variables. The Mann-Whitney U test was used to compare the average number of discomfort symptoms among HRVD and LRVD teachers. Results A moderate positive correlation was observed between the average number, frequency, and intensity of discomfort symptom and the total score, physical domain score, and limitation domain score of the VoiSS. Only the emotional domain score of the VoiSS showed a weak positive correlation ( p < 0.001). Teachers considered in the HRVD group according to the VoiSS score had a higher number, frequency, and intensity of vocal tract discomfort symptoms. Conclusion There is correlation between the VTDS and VoiSS scales. Like the VoiSS, the VTDS is a questionnaire that detects HRVD teachers. Therefore, the results suggest that both questionnaires could be useful for a preventive voice program for Italian teacher

Cerebrospinal fluid leak during stapes surgery: Gushing leaks and oozing leaks, two different phenomena.

Cerebrospinal fluid (CSF) leak is an uncommon event that can occur during stapes surgery. Such leaks can be classified as gushing leaks (stapes gushers) and oozing leaks. A stapes gusher is a massive flow of CSF through the perforated footplate that fills the middle ear suddenly, while an oozing leak is a slower and less profuse flow. We conducted a retrospective, observational, multicenter study of 38 patients—23 men and 15 women, aged 23 to 71 years (mean: 47)—who had experienced a CSF leak during stapes surgery. Patients were divided into various groups according to the type of surgical procedure performed and the type of postoperative complications they experienced. Audiometric and clinical evaluations were carried out pre- and postoperatively. Correlations among surgical variations (total or partial stapedectomy, placement of a prosthesis), hearing outcomes, and the incidence of postoperative complications (postoperative CSF leak and vertigo) were studied. Our statistical analysis revealed that gushing leaks and oozing leaks result in different degrees of hearing impairment and different rates of complications. We recommend that an individual approach be used to manage these complications